lisinopril and Diarrhea

Topics: Angioedema; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Austria; Diarrhea; Dyspepsia; Humans; Incidence; Lisinopril; Nausea; Pyridines; Randomized Controlled Trials as Topic; Retrospective Studies; Thiazepines; Urticaria; Vomiting

ACE inhibitors (ACEi) are common anti-hypertensive drugs that can cause angioedema. Though classic, or facial angioedema is rare, visceral angioedema is even less common. When angioedema occurs, it typically presents early, within 30 days of initiating therapy. Visceral angioedema most commonly presents with nausea, emesis, abdominal pain and diarrhoea, and thus is often mistaken for an episode of gastroenteritis. When a CT scan is obtained, it typically shows characteristic findings, including ascetic fluid, mild mesenteric oedema and thickening of the small bowel. In this case report, we present a patient who did not experience her first episode of visceral angioedema until after she had been on ACEi therapy for 5-7 years. In addition, she experienced recurrent episodes of visceral angioedema that were separated by approximately 4 years at a time. Both of these features make for a particularly unique presentation.

Topics: Abdominal Pain; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Anti-Allergic Agents; Diagnosis, Differential; Diarrhea; Female; Glucocorticoids; Histamine H2 Antagonists; Humans; Lisinopril; Middle Aged; Nausea; Tomography, X-Ray Computed; Treatment Outcome; Viscera

Peripheral angioedema of the face and upper airways is a well-known phenomenon of angiotensin-converting enzyme inhibitors occurring in only 0.1% to 0.7% of patients. We describe a case of the even less-common manifestation of visceral angioedema, which causes symptoms of chronic and intractable diarrhea.. A 68-year-old white woman presented with large-volume diarrhea, caused by visceral angioedema secondary to lisinopril therapy. Initial imaging studies were significant for distended small bowel loops, with subsequent unremarkable findings on colonoscopy and biopsy studies. After an exhaustive laboratory work-up, her diarrhea resolved only after the discontinuation of lisinopril.. Use of angiotensin-converting enzyme inhibitors is increasing, making the recognition of visceral angioedema important in preventing significant morbidity and avoiding invasive and costly studies.

Topics: Aged; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Chronic Disease; Diarrhea; Female; Humans; Lisinopril

To report a case of possible lisinopril-induced angioedema of the small bowel.. A 67-year-old female was admitted to the hospital with abdominal pain, nausea, vomiting, and diarrhea. A computed tomography (CT) scan of the abdomen/pelvis was obtained which showed wall thickening around the area of the jejunum and scant ascites consistent with several diagnoses, including small bowel angioedema. She was treated with intravenous fluids and nasogastric decompression. Stool studies were negative. Her lisinopril was held due to the possibility of small bowel angioedema. A CT enterography obtained 5 days after the discontinuation of lisinopril showed complete resolution of the inflammatory changes and perihepatic fluid. It was felt that angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema of the small bowel was the most likely etiology of her symptoms.. Angiotensin-converting enzyme inhibitor small bowel angioedema is an uncommon cause of abdominal symptoms. In several cases, patients had been taking ACEIs for years before symptoms occur. Treatment includes cessation of the ACEI and supportive care.. Angiotensin-converting enzyme inhibitor-related small bowel angioedema should be considered in the differential diagnosis of unexplained abdominal pain.

Topics: Abdominal Pain; Aged; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Diagnosis, Differential; Diarrhea; Female; Humans; Intestinal Diseases; Intestine, Small; Lisinopril; Nausea; Time Factors; Tomography, X-Ray Computed; Vomiting

Four patients presented to the emergency room with life-threatening hyperkalemia and concomitant watery diarrhea. Hypovolemia, acidosis, and renal insufficiency were present in all 4 cases. In 2 patients, hyperkalemia followed initiation of angiotensin-converting enzyme (ACE) inhibitor therapy, whereas 1 patient experienced hyperkalemia after a dose increase of an ACE inhibitor, and the fourth patient was on continuous ACE-inhibitor therapy at the time of the hyperkalemia episode. Two of the 3 patients with functioning kidneys required hemodialysis to correct the hyperkalemia, whereas the other patient was on long-term hemodialysis therapy. In the 2 patients in whom transtubular potassium (K+) gradients were available, their values ranged far below normal, indicating tubular failure to secrete K+. This abnormality was attributed to decreased distal delivery of sodium and water and to renin/angiotensin II/aldosterone blockade. It has been proposed that aldosterone blockade impairs the capacity of the colonic epithelial cells to secrete K+. In all 4 patients the watery diarrhea ceased in parallel with the correction of serum K+ to normal values. It is suggested that hyperkalemia, most likely by stimulating intestinal motility, induced the watery diarrhea in all 4 patients. The watery diarrhea, however, failed to compensate for the renal tubular failure to secrete K+.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Diarrhea; Humans; Hyperkalemia; Lisinopril; Male; Renal Dialysis

Topics: Adult; Anaphylaxis; Angiotensin-Converting Enzyme Inhibitors; Antirheumatic Agents; Arthritis, Rheumatoid; Diarrhea; Drug Interactions; Female; Gold Sodium Thiosulfate; Humans; Lisinopril; Paresthesia; Skin Diseases

We describe a patient who developed lithium toxicity when lisinopril was substituted for clonidine. Possible mechanisms of angiotensin-converting enzyme (ACE) inhibitor-induced lithium toxicity are discussed. Aggressive serum lithium concentration monitoring and a reduction in the dose of lithium is advised when using ACE inhibitors because of disturbances and shifts in fluid and electrolyte balance.

Topics: Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Diarrhea; Drug Interactions; Enalapril; Female; Humans; Hypertension; Lisinopril; Lithium; Middle Aged