Long-term diuretic treatment of patients with congestive heart failure is often complicated by hyponatremia and resistance to diuretic treatment, as well as by hypokalemia. Less widely recognized is the increase in intracellular sodium in the presence of hyponatremia, and loss of magnesium, caused by sustained diuretic therapy. Because the sodium pump, which maintains intracellular sodium and potassium against a concentration gradient, is dependent on optimal magnesium levels, we have investigated the influence of magnesium infusions on serum and skeletal muscle levels of sodium and potassium in congestive heart failure patients with electrolyte disturbances. Because aldosteronism, such as accompanies the disease and diuretic treatment, increases intracellular sodium, we have measured intracellular sodium and potassium in six patients given a new aldosterone antagonist (canrenone). It lowered the muscle sodium and raised the muscle potassium and magnesium, and slightly raised the serum sodium. The magnesium infusions, given to eight patients, significantly increased the serum sodium and lowered the muscle sodium levels, and normalized both serum and subnormal muscle potassium levels.