KMID : 1128320130110020056
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Electrolytes & Blood Pressure 2013 Volume.11 No. 2 p.56 ~ p.59
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Severe Hyponatremia Associated with the Use of Angiotensin II Receptor Blocker/thiazide Combinations
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Kim Da-Rae
Cho Joo-Hee Jang Won-Seok Kim Jin-Sug Jeong Kyung-Hwan Lee Tae-Won Ihm Chun-Gyoo
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Abstract
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There are several widely used combinations of angiotensin II receptor blocker (ARB)/ thiazide. The complimentary mechanism of action for such antihypertensive therapies is that, while ARB inhibits the vasoconstricting and aldosterone-secreting effects of angiotensin II, hydrochlorothiazide affects the renal tubular mechanisms of electrolyte reabsorption and increases excretion of sodium and chloride in the distal tubule, consequently promoting water excretion. In addition, hypokalemia, which may be triggered by a hydrochlorothiazide-induced increase in urinary potassium loss, is resisted by the use of ARB. Hence, the ARB/thiazide combination is safe in terms of potassium imbalance. For these reasons, fixed-dose ARB/thiazide combination anti-hypertensive drugs have been widely used for the treatment of hypertension. However, there have not been many studies done regarding cases where patients under such regimens showed severe hyponatremia,even when the amount of thiazide included was low. Here we report two cases in which severe hyponatremia occurred following treatment with the ARB/thiazide combinations. Upon discontinuation of the regimen, both patients showed recovery from hyponatremia.
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KEYWORD
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Angiotensin II type 1 receptor blockers, Hydrochlorothiazide, Hyponatremia
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