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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Captopril and spironolactone therapy for refractory congestive heart failure.Am J Cardiol. 1993; 71: 29A-33A
- Spironolactone in congestive heart-failure refractory to high-dose loop diuretic and low-dose angiotensin-converting enzyme inhibitor.Am J Cardiol. 1993; 71: 21A-28A
- Effects of spironolactone and angiotensin-converting-enzyme inhibitor on left ventricular hypertrophy in patients with essential hypertension.Hypertens Res. 1999; 22: 17-22
- The effect of spironolactone on morbidity and mortality in patients with severe heart failure.N Engl J Med. 1999; 341: 709-717
- Life-threatening hyperkalaemia caused by angiotensin-converting enzyme inhibitors and diuretics.Diabetic Med. 1997; 14: 169-170
- Hyperkalaemia.J Am Soc Nephrol. 1998; 9: 1535-1543
- Iatrogenic hyperkalaemia—points to consider in diagnosis and management.Nephrol Dial Transplant. 1997; 13: 2402-2406
- Posture as a contributing factor to beta-blockade induced hyperkalaemia.Eur J Clin Pharmacol. 1985; 28: 359-360
- Digitalis intoxication and hyperkalaemia in hemodialysed patients.Int J Artif Organs. 1981; 4: 149-150
- Spironolactone and congestive heart failure.Lancet. 2000; 355: 1369-1370
- Effectiveness of spironolactone added to an angiotensin-converting-enzyme inhibitor and a loop diuretic for severe chronic congestive heart failure.Am J Cardiol. 1996; 78: 902-907
- Effects of enalapril on mortality in severe congestive heart failure.N Engl J Med. 1987; 316: 1429-1435
- Hyperkalaemia in diabetes.Postgrad Med J. 1995; 71: 551-552
Bonnet F, Thivolet CH. Reversible hyperkalaemia at the initiation of ACE inhibitors in a young diabetic patient with latent hyporeninemic hypoaldosteronism. Diabetes Care. 1996;19:781. Letter.
- Hyperkalaemia in diabetes mellitus—potential hazards of coexisting hyporeninemic hypoaldosteronism.Postgrad Med J. 1984; 60: 370-373
- Angiotensin-converting enzyme inhibitors and renal function in heart failure.Am J Cardiol. 1992; 70: 119C-125C
- Incidence of hyperkalaemia induced by indomethacin in a hospital population.BMJ. 1985; 291: 107-108
- Indomethacin-associated hyperkalaemia in the elderly.J Am Geriatr Soc. 1983; 31: 371-373
- Reversible acute renal insufficiency and hyperkalaemia following indomethacin therapy.JAMA. 1981; 246: 154-155
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.