Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and enalapril

Castrillón, José Luis Pérez; Mediavilla, A.; Mendez, Michelle A.; Cavada, E.; Carrascosa, Miguel F; Valle, Roberto

doi:10.1111/j.1365-2796.1993.tb00655.x

Cited by 25 publications

(12 citation statements)

References 6 publications

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“…Angiotensin I is transformed in angiotensin II in the brain, and angiotensin II is known to stimulate ADH secretion and to have an important dipsogenic action 4 . Moreover, ACE inhibitors decrease the metabolism of bradykinin, and the consequent increase in bradykinin concentration may also stimulate the secretion of vasopressin 3 …”

mentioning

confidence: 99%

Severe Hyponatremia Associated With Ramipril Therapy in an Old Woman

Tilly-Gentric

1995

J American Geriatrics Society

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mentioning

confidence: 99%

Severe Hyponatremia Associated With Ramipril Therapy in an Old Woman

Tilly-Gentric

1995

J American Geriatrics Society

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“…Angiotensin-converting enzyme inhibitors also have been associated rarely with SIADH. 13,14 However, our patient had been taking benazepril at a stable dosage for 3 weeks before admission and throughout hospitalization, and her serum sodium concentrations were in the normal range until day 7 of hospitalization.…”

Section: Discussionmentioning

confidence: 84%

Fentanyl‐Associated Syndrome of Inappropriate Antidiuretic Hormone Secretion

2002

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A 43-year-old woman with advanced pulmonary blastoma was admitted for worsening back pain. Her drug regimen included hydromorphone and benazepril. On admission, hydromorphone patient-controlled analgesia (PCA) was started for acute pain control and dexamethasone for possible cord compression. Baseline laboratory tests were unremarkable, but magnetic resonance imaging revealed T3 and L3 lesions. Irradiation was started with improvement in her pain. In anticipation of discharge, a fentanyl transdermal patch was given, and PCA was tapered. Two days later, the patient became progressively confused and fell. Neurologic examination and computed brain tomography were normal. Her serum sodium was 119 mEq/L (normal 136-144 mEq/L) and was confirmed on repeat testing, urine sodium was 194 mEq/L, and urine and serum osmolalities were 554 mOsm/kg (normal 300-900 mOsm/kg) and 245 mOsm/kg (normal 280-300 mOsm/kg), respectively, consistent with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Fluids were restricted, hydromorphone PCA was started again, and fentanyl was discontinued. After 36 hours, her serum sodium increased to 136 mEq/L. Because we were unsure whether the fentanyl or her cancer was causative and were unable to find any published reports of fentanyl-associated SIADH, we readministered the fentanyl patch 2 days later. Within 48 hours, serum sodium dropped to 123 mEq/L. Fentanyl was discontinued, fluids were restricted, and 3% saline was started. Her serum sodium increased to 132 mEq/L in 48 hours. The patient was prescribed oral hydromorphone and benazepril and was discharged. The repeated temporal relationship between the administration of fentanyl and the onset of SIADH strongly implicates fentanyl as the causative agent in this case. To our knowledge, this is the first report of fentanyl-associated SIADH.

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“…We searched PubMed for the key words “ACE inhibitor, SIADH” and “ACE inhibitor, hyponatremia,” and extracted 14 case reports in reference to the Saeed et al diagnostic criteria for SIADH (Table 1). 3–17 Although those criteria include no recent use of diuretic agents, we believe that hyponatremia, which is often multifaceted, can result from both the use of diuretic agents and inappropriate ADH secretion. Consequently, we also extracted reports on patients undergoing diuretic therapy for hyponatremia to collect as much research as possible regarding the association between ACE inhibitors and ADH hypersecretion.…”

Section: Discussionmentioning

confidence: 99%

“…Because two of four patients who relapsed when ACE inhibitors were reintroduced after cessation had improved their hyponatremia, we cannot recommend this approach. 4,8–10 The mechanisms of action of calcium antagonists, alpha-1 antagonists and ACE inhibitors differ. To the best of our knowledge, an ARB has not induced SIADH, and a renin–angiotensin system inhibitor has the same effect as an ACE inhibitor.…”

Section: Discussionmentioning

confidence: 99%

Syndrome of inappropriate secretion of antidiuretic hormone associated with angiotensin-converting enzyme inhibitor therapy in the perioperative period

Nakayama

Fujisaki

Hirai

et al. 2019

J Renin Angiotensin Aldosterone Syst

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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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Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and enalapril

Cited by 25 publications

References 6 publications

Severe Hyponatremia Associated With Ramipril Therapy in an Old Woman

Severe Hyponatremia Associated With Ramipril Therapy in an Old Woman

Fentanyl‐Associated Syndrome of Inappropriate Antidiuretic Hormone Secretion

Syndrome of inappropriate secretion of antidiuretic hormone associated with angiotensin-converting enzyme inhibitor therapy in the perioperative period

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