Dear Colleagues
ACEIs are widely prescribed for the treatment of
hypertension, CCF and diabetic nephropathy. Clinicians
are aware of hyperkalaemia and renal impairment as
side effects of these drugs but are less aware of
hyponatraemia. Increasingly, I have been seeing cases
of moderate to severe hyponatraemia with normokalaemia
or mild hyperkalaemia associated with their use. ACEIs
cause a state of hyper-reninaemic hypoaldosteronism
leading to renal salt wastage. They also cause water
retention due inappropriate ADH secretion induced by
raised kinins and brain angiotensin II acting on the
hypothalamus. Both mechanisms can lead to
hyponatraemia. I would be grateful to share the
experience of colleagues who have noticed a similar
increase in this practical problem.
regards.
=====
Dr. M A Al-Jubouri
Consultant Chemical Pathologist
Whiston Hospital
Prescot
Merseyside L35 5DR
UK
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