enalapril and Inappropriate-ADH-Syndrome

Topics: Enalapril; Humans; Hyponatremia; Inappropriate ADH Syndrome; Vasopressins

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Enalapril; Humans; Inappropriate ADH Syndrome; Male

Seventeen cases of severe hyponatremia induced by angiotensin-converting enzyme (ACE) inhibitor therapy have been reported in the literature. The mechanism of severe hyponatremia induced by ACE inhibitor is not clear. A 60-year-old white man with a history of idiopathic dilated cardiomyopathy was treated with enalapril, 20 mg daily, that had been started 2 weeks before heart transplantation. The serum sodium level was 138 mmol/L before initiation of enalapril therapy and 127 mmol/L just before cardiac surgery. In the post-heart transplantation period, enalapril therapy was withdrawn for the perianesthesia period, and the serum sodium level increased from 127 to 140 mmol/L. One month later, viral myocarditis developed in the patient and enalapril was reintroduced at 20 mg daily. Two weeks later, natremia decreased. Enalapril was discontinued. Three days later the serum sodium level rose to 140 mmol/L. Severe symptomatic hyponatremia induced by the syndrome of inappropriate secretion of antidiuretic hormone should be considered a rare but possible complication associated with ACE inhibitor therapy.

Topics: Angiotensin-Converting Enzyme Inhibitors; Cardiomyopathy, Dilated; Enalapril; Heart Transplantation; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Middle Aged; Sodium

This report describes three cases of hyponatraemia/syndrome of inappropriate secretion of antidiuretic hormone. The cases are most likely caused by treatment/intoxication with three different selective serotonin reuptake inhibitors: Fluoxetine, paroxetine and citalopram. All three patients were elderly women (75-83 years). Serum sodium values returned to normal or near normal after discontinuation of the drug and concomitant fluid restriction. Hyponatraemia has previously been described as an adverse effect to fluoxetine and paroxetine, but not to citalopram.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Antidepressive Agents, Second-Generation; Antihypertensive Agents; Enalapril; Female; Fluoxetine; Humans; Hyponatremia; Inappropriate ADH Syndrome; Paroxetine; Selective Serotonin Reuptake Inhibitors

A 69-year-old woman with a history of diabetes and hypertension, was referred to the Hospital of Laredo because of hyponatraemia. She had weakness and slight dyspnoea with no evidence of extracellular fluid volume depletion or oedema. Serum sodium level on admission was 125 mol l-1, plasma osmolality 270 mosmol kg-1, simultaneous urine osmolality was 580 mosmol kg-1 and urine sodium 32.6 mmol l-1. She had been treated with enalapril (20 mg) daily for 4 months. She was diagnosed with the Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) that was reversed after cessation of treatment with enalapril and reappeared on reintroduction of the drug at the same daily doses.

Topics: Aged; Enalapril; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Osmolar Concentration