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Can ACE-I Be a Silent Killer While Normal Renal Functions Falsely Secure Us?
The current case report represents a warning against serious hyperkalaemia and acidosis induced by ACE-I during surgical stress while normal renal function could deceive the attending anaesthetist. Arterial gas analysis for follow-up of haemoglobin loss accidentally discovered hyperkalaemia and acid...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6077600/ https://www.ncbi.nlm.nih.gov/pubmed/30112218 http://dx.doi.org/10.1155/2018/1852016 |
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author | Abdelaal Ahmed Mahmoud, Ahmed Campbell, Mark Blajeva, Margarita |
author_facet | Abdelaal Ahmed Mahmoud, Ahmed Campbell, Mark Blajeva, Margarita |
author_sort | Abdelaal Ahmed Mahmoud, Ahmed |
collection | PubMed |
description | The current case report represents a warning against serious hyperkalaemia and acidosis induced by ACE-I during surgical stress while normal renal function could deceive the attending anaesthetist. Arterial gas analysis for follow-up of haemoglobin loss accidentally discovered hyperkalaemia and acidosis. Glucose-insulin and furosemide successfully corrected hyperkalaemia after 25 minutes and acidosis after 3 hours. These complications could be explained by a deficient steroid stress response to surgery secondary to suppression by ACE-I. Event analysis and database search found that ACE-I induced aldosterone deficiency aggravated by surgical stress response with an inadequate increase in aldosterone secretion due to angiotensin II deficiency as a sequel of ACE-I leading to defective secretion of H+ and K+. Furosemide is recommended to secrete H+ and K+ compensating for aldosterone deficiency in addition to other antihyperkalaemia measures. Anaesthetising an ACE-I treated patient requires considering ACE-I as a potential cause of hyperkalaemia and acidosis. |
format | Online Article Text |
id | pubmed-6077600 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-60776002018-08-15 Can ACE-I Be a Silent Killer While Normal Renal Functions Falsely Secure Us? Abdelaal Ahmed Mahmoud, Ahmed Campbell, Mark Blajeva, Margarita Case Rep Anesthesiol Case Report The current case report represents a warning against serious hyperkalaemia and acidosis induced by ACE-I during surgical stress while normal renal function could deceive the attending anaesthetist. Arterial gas analysis for follow-up of haemoglobin loss accidentally discovered hyperkalaemia and acidosis. Glucose-insulin and furosemide successfully corrected hyperkalaemia after 25 minutes and acidosis after 3 hours. These complications could be explained by a deficient steroid stress response to surgery secondary to suppression by ACE-I. Event analysis and database search found that ACE-I induced aldosterone deficiency aggravated by surgical stress response with an inadequate increase in aldosterone secretion due to angiotensin II deficiency as a sequel of ACE-I leading to defective secretion of H+ and K+. Furosemide is recommended to secrete H+ and K+ compensating for aldosterone deficiency in addition to other antihyperkalaemia measures. Anaesthetising an ACE-I treated patient requires considering ACE-I as a potential cause of hyperkalaemia and acidosis. Hindawi 2018-07-09 /pmc/articles/PMC6077600/ /pubmed/30112218 http://dx.doi.org/10.1155/2018/1852016 Text en Copyright © 2018 Ahmed Abdelaal Ahmed Mahmoud et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Abdelaal Ahmed Mahmoud, Ahmed Campbell, Mark Blajeva, Margarita Can ACE-I Be a Silent Killer While Normal Renal Functions Falsely Secure Us? |
title | Can ACE-I Be a Silent Killer While Normal Renal Functions Falsely Secure Us? |
title_full | Can ACE-I Be a Silent Killer While Normal Renal Functions Falsely Secure Us? |
title_fullStr | Can ACE-I Be a Silent Killer While Normal Renal Functions Falsely Secure Us? |
title_full_unstemmed | Can ACE-I Be a Silent Killer While Normal Renal Functions Falsely Secure Us? |
title_short | Can ACE-I Be a Silent Killer While Normal Renal Functions Falsely Secure Us? |
title_sort | can ace-i be a silent killer while normal renal functions falsely secure us? |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6077600/ https://www.ncbi.nlm.nih.gov/pubmed/30112218 http://dx.doi.org/10.1155/2018/1852016 |
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