Life-Threatening Hyperkalemia Associated With Captopril Administration

Doman, Kathleen A.; Perlmutter, Jeffrey A.; Muhammedi, Muhammed; Puschett, Jules B.

doi:10.1097/00007611-199311000-00019

Cited by 6 publications

(4 citation statements)

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“…Although hyperkalemia from ACEI is uncommon in patients with normal renal functions, reports of fatal hyperkalemia from ACEI exist in the literature [11][12][13][14]. It is likely that patients with CRF, who have diabetes and congestive heart failure, are at higher risk of hyperkalemia from ACEI due to preexisting defects in potassium hemostasis.…”

Section: Introductionmentioning

confidence: 99%

Predictors of the Development of Hyperkalemia in Patients Using Angiotensin-Converting Enzyme Inhibitors

Ahuja¹,

Freeman

Mahnken

et al. 2000

Am J Nephrol

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Background/Aims: Angiotensin-converting enzyme inhibitors (ACEI) are the antihypertensives of choice in patients with chronic renal failure (CRF). ACEI by decreasing the synthesis of aldosterone, the main regulator of serum potassium, predispose to the development of hyperkalemia. Although hyperkalemia with administration of ACEI is uncommon in patients with a normal renal function, a preexisting abnormality in potassium hemostasis, as seen in patients with chronic renal failure, may increase the risk of hyperkalemia. Method: To determine the predictors of development of hyperkalemia (K >5.1 mEq/l) in patients on ACEI, we retrospectively reviewed medical records of 119 patients followed in our renal clinic. Results: The mean age of the patients was 56 ± (SD) 13 (range 20–84) years. Sixty-three percent were males, and 37% were females. Sixty-seven percent had a history of diabetes. Eighty five percent of the patients had CRF [creatinine clearance (CrCl) <80 ml/min]. The baseline serum Cr was 2.3 ± 1.2 (range 0.6–6.9) mg/dl, and the CrCl was 50 ± 27.5 ml/min. Of the 119 patients 46 (38.6%) developed hyperkalemia (mean K 5.68 ± 0.3, range 5.2–6.7 mEq/l). Ninety-six percent of the patients who developed hyperkalemia had CRF, and 84% were diabetics. Pearson product-moment correlation revealed a significant positive correlation of hyperkalemia with Cr and a negative correlation of hyperkalemia with CrCl and HCO₃ (Cr: r = 0.42, p < 0.0001; CrCl: r = –0.34, p < 0.0001; HCO₃: r = –0.41, p < 0.0001). Multivariate logistic regression analysis revealed diabetes and serum creatinine to be the main predictors of hyperkalemia. In 31 patients hyperkalemia resolved either with a low-potassium (2 g/day) diet or with diet and a decrease in the dose of ACEI. In 15 patients ACEI had to be discontinued due to persistent hyperkalemia. Conclusions: We conclude that hyperkalemia is common in patients with CRF on ACEI. The majority of the patients who develop hyperkalemia on ACEI have CRF and diabetes. A large number of patients with CRF require discontinuation of ACEI due to hyperkalemia and are deprived of their renoprotective effects.

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Section: Introductionmentioning

confidence: 99%

Predictors of the Development of Hyperkalemia in Patients Using Angiotensin-Converting Enzyme Inhibitors

Ahuja¹,

Freeman

Mahnken

et al. 2000

Am J Nephrol

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“…[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] Life-threatening hyperkalemia during use of ACE inhibitors, although rare, has been reported. [43][44][45][46] Consequently, physicians often carefully monitor potassium levels when ACE inhibitors are prescribed. However, there are little data to guide the intensity of such monitoring.…”

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confidence: 99%

Hyperkalemia in Outpatients Using Angiotensin-Converting Enzyme Inhibitors

Reardon

Macpherson²

1998

Arch Intern Med

202

114

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“…Aufgrund neuerer Studien können ACE-Hemmer auch als allgemein vasoprotektiv wirkende Medikamente angesehen werden (5,11). Mögliche Nebenwirkungen einer ACE-Hemmer-Therapie können vor allem eine Hyperkaliämie und eine passagere Nierenfunktionsstörung sein (2); in seltenen Fällen können diese Komplikationen auch lebensbedrohlich werden (3,4). Eine präexistente schwergradige Niereninsuffizienz gilt prinzipiell als Kontraindikation für eine neu beginnende ACE-Hemmer-Therapie (10,17).…”

Section: Diskussionunclassified

“…Über das Hyperkaliämierisiko bei mehrjähriger ACEHemmer-Therapie kann nur durch entsprechend lang durchgeführte Studien eine Aussage gemacht werden. Mail: georg.biesenbach@akh.linz.at Tab 4. Patientencharakteristika und Anstieg des Serum-Kaliumspiegels unter der ACE-Hemmer-Therapie bei den Typ 2-Diabetikern mit und ohne gleichzeitige Diuretika-Therapie.…”

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