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purpose
To review the effects of heparin and heparinoid compounds on aldosterone physiology
and associated induction of hyperkalemia.
materials and methods
A comprehensive literature search (of human and animal data) was carried out by computer
and by using reference citations from primary sources.
results
Heparin and its congeners are predictable, potent inhibitors of aldosterone production.
This inhibitory effect is specific for the zona glomerulosa; other corticosteroids
are not affected. Aldosterone suppression occurs within a few days of initiation of
therapy, is reversible, and is independent of either anticoagulant effect or route
of administration. Decreases in aldosterone levels may occur with heparin dosages
as low as 5,000 U bid. The most important, but probably not the only mechanism of aldosterone inhibition
appears to involve reduction in both the number and affinity of the angiotensin-II
receptors in the zona glomerulosa. Prolonged use of heparin causes marked reduction
in the width of the adrenal zona glomerulosa.
conclusions
Aldosterone suppression results in natriuresis and less predictably in decreased excretion
of potassium. Greater than normal serum potassium levels occur in about 7% of patients,
but marked hyperkalemia generally requires the presence of additional factors perturbing
potassium balance (in particular, renal insufficiency, diabetes mellitus, or the use
of certain medications). Heparin-induced increases in serum potassium need to be better
anticipated by clinicians. Serum potassium levels should be monitored periodically
in patients being given heparin for 3 or more days, and in patients at relatively
high risk for hyperkalemia, the monitoring interval should probably be no greater
than 4 days.
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Article Info
Publication History
Accepted:
February 20,
1995
Received:
October 27,
1994
Identification
Copyright
© 2004 Published by Elsevier Inc.
