Abstract
Purpose: The beneficial effects of spironolactone are additive to those of ACE inhibitors
among patients with heart failure and/or hypertension; however, it is essential to
identify patients prone to develop serious hyperkalemia during combined treatment
and to evaluate the associated morbidity and mortality.
Subjects and methods: We studied 25 patients treated with ACE inhibitors and spironolactone
who were admitted to the emergency room with a serum potassium level >6 mmol/L. Patients
were followed up for at least one month after admission.
Results: The mean age of the patients (11 males, 14 females) was 74 ± 13 years. Five
patients were diabetics. On admission, the serum potassium was 7.7 ± 0.7 mmol/L and
the serum creatinine was 3.8 ± 1.8 mg/dL; these values were significantly higher than
the most recent follow-up laboratory measurements (4.6 ± 0.5 mmol/L and 1.9 ± 1.2
mg/dL, respectively) obtained at 13 ± 5 weeks before admission. The arterial pH on
admission was 7.3 ± 0.1 and the plasma bicarbonate was 18 ± 5 mmol/L. The main causes
for acute renal failure were dehydration (n = 12) and worsening heart failure (n =
9). The mean daily dose of spironolactone was 57 ± 32 mg and 12 patients were concomitantly
treated with other drugs that may cause hyperkalemia. Two patients died, and 2 patients
were resuscitated but survived. Hemodialysis was necessary in 17 patients; 12 patients
were admitted to the intensive care unit. The mean duration of hospitalization was
12 ± 6 days. Two patients needed to be started on maintenance hemodialysis therapy.
Conclusion: A combination of ACE inhibitors and spironolactone should be considered
with caution and monitored closely in patients with renal insufficiency, diabetes,
older age, worsening heart failure, a risk for dehydration, and in combination with
other medications that may cause hyperkalemia. A daily spironolactone dose of 25 mg
should not be exceeded.
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Article Info
Publication History
Accepted:
December 19,
2000
Received in revised form:
December 19,
2000
Received:
June 13,
2000
Identification
Copyright
© 2001 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
