ACEI and low sodium

• angiotensin converting enzyme (ACE) inhibitors have been associated with dilutional hyponatremia (1,2,3):
  
  
  • ACE inhibitors alone can precipitate hyponatremia without co-administration of thiazide diuretics
    
    
  • hyponatremia induced by ACE inhibitors appears to be dilutional and is accompanied by features of SIADH
    
    
  • discontinuing the ACE inhibitor leads to resolution of the hyponatremia.

Reference:

• Subramanian D, Ayus C. Case report: Severe symptomatic hyponatremia associated with lisinopril therapy. Am J Med Sci 1992;303: 177-179.
• Gonzalez-Martinez H et al. Hyponatremia due to enalapril in an elderly patient. A case report. Arch Fam Med. 1993 Jul;2(7):791-3
• Izzedine H et al. Angiotensin-converting enzyme inhibitor-induced syndrome of inappropriate secretion of antidiuretic hormone: case report and review of the literature. Clin Pharmacol Ther. 2002 Jun;71(6):503-7.