Chronic asymptomatic hyponatraemia following angiotensin receptor blocker-neprilysin inhibitor (ARNi) therapy: a case report

Introduction Sacubitril/valsartan is a fixed dose combination of a neprilysin inhibitor (sacubitril) and an AT1 receptor blocker (valsartan), referred to as an angiotensin receptor-neprilysin inhibitor (ARNi). Its indication is in the treatment of heart failure with reduced ejection fraction (HFrEF).1 Hyponatraemia has only been reported once2 as an adverse drug reaction. We here contribute what we believe is the first reported case of ARNi induced chronic asymptomatic severe hyponatraemia, discovered incidentally by routine laboratory testing. Case presentation A middle-aged woman with a medical history of Cushing’s syndrome, myocardial infarction (MI), Graves’ disease and HFrEF (secondary to previous MI, ejection fraction originally=29%, now 45% after medical therapy) was discovered to have severe hyponatraemia on a routine follow-up visit to her cardiologist. She has had normal cortisol levels following a left adrenalectomy for Cushing’s syndrome 7 years ago. She developed Graves’ disease 6 years...
Source: Postgraduate Medical Journal - Category: General Medicine Authors: Tags: Adverse drug reactions Source Type: research