title: [Severe complications during enalapril therapy for heart insufficiency].
abstract: In 3 patients with severe cardiac failure high dose therapy with the ACE inhibitor enalapril was instituted during a state of extracellular volume depletion. Severe arterial hypotension with reversible renal insufficiency developed in all the patients. In two the hypovolemia was induced by diuretic treatment and in one by an acute infection with diarrhea. The latter patient also developed life-threatening hyperkalemia with cardiac arrest since he was also receiving spironolactone and potassium supplements. These cases demonstrate that ACE inhibitors should not be instituted during extracellular volume depletion and their initial dosage should be low. The dangerous combination of ACE inhibitors with spironolactone and potassium supplements should be avoided wherever possible.
authors.affiliation: Medizinische Universitätsklinik, Inselspital, Bern.
authors.forename: T
authors.initials: T
authors.lastname: Wieland
authors.forename: M
authors.initials: M
authors.lastname: Stäubli
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D004347:Drug Interactions; D004656:Enalapril / Q000009:adverse effects*; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000009:adverse effects; D013148:Spironolactone / Q000009:adverse effects; D014883:Water-Electrolyte Imbalance / Q000503:physiopathology*
chemical_list: D013148:Spironolactone; D004656:Enalapril; D011188:Potassium
vernacular_title: Schwerwiegende Komplikationen unter Enalapril-Therapie wegen Herzinsuffizienz.