RAPID LIFE-THREATENING HYPERKALEMIA AFTER ADDITION OF AMILORIDE HCL HYDROCHLOROTHIAZIDE TO ANGIOTENSIN-CONVERTING ENZYME-INHIBITOR THERAPY

study objective: To highlight the dangers of a precipitous rise in ser um potassium levels in patients at risk for renal insufficiency, alrea dy receiving an angiotensin-converting enzyme (ACE) inhibitor, who are given a potassium-sparing diuretic. Methods: We conducted a retrospec tive chart review of five patients who were taking the above combinati on of medications who were seen in our ED with hyperkalemia. Results: All five patients had diabetes and were older than 50 years of age. Ex cept for one patient, they had some degree of renal impairment and all were receiving an ACE inhibitor. Each had amiloride HCl/hydrochloroth iazide added to their therapeutic regimen 8 to 18 days before presenti ng to our ED with hyperkalemia. Potassium levels were between 9.4 and 11 mEq/L in 4 of the patients; 2 did not respond to resuscitation meas ures. Conclusion: The concomitant use of ACE inhibitor and potassium-s paring diuretic therapy should be avoided. If impossible, weekly monit oring of both renal function and serum potassium should be performed. In the ED patients who are receiving such a combination should receive immediate ECG monitoring.