Nakayama T, Fujisaki H, Hirai S, Kawauchi R, Ogawa K, Mitsui A, Hirano K, Isozumi K, Takahashi T, Komatsumoto S. Syndrome of inappropriate secretion of antidiuretic hormone associated with angiotensin-converting enzyme inhibitor therapy in the perioperative period.
J Renin Angiotensin Aldosterone Syst 2019;
20:1470320319834409. [PMID:
30843458 PMCID:
PMC6407162 DOI:
10.1177/1470320319834409]
[Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
Angiotensin-converting enzyme (ACE) inhibitors are one of the most commonly
used medications for hypertension. Rarely, ACE inhibitors have the potential
to cause a syndrome of inappropriate secretion of antidiuretic hormone
(SIADH).
Case presentation:
A 70-year-old woman with > 10 years ACE inhibitor therapy with
normonatremia suddenly developed severe SIADH when she took a liquid diet in
the uneventful perioperative period, with hemodynamic stability and no
surgical complications. She promptly recovered from SIADH subsequent to
discontinuing the ACE inhibitor therapy and changing her diet. Therefore, it
was assumed that excess antidiuretic hormone secretion due to an ACE
inhibitor and free water load from the liquid diet contributed to
hyponatremia in our patient.
Conclusion:
Patients treated with an ACE inhibitor can latently experience inappropriate
secretion of antidiuretic hormone, and rapidly develop severe hyponatremia
together with additional factors affecting water or salt homeostasis
regardless of the length of the administration duration. Clinicians should
monitor serum sodium levels in such patients not only just after the
initiation of ACE inhibitors but also upon the appearance of those
factors.
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