Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Severe hepatic encephalopathy in a patient with liver cirrhosis after administration of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker combination therapy: a case report. | Oertelt-Prigione et al. Journal of Medical Case Reports 2010 4 141 http content 4 1 141 jA CASE REPORTS CASE REPORT Open Access Severe hepatic encephalopathy in a patient with liver cirrhosis after administration of angiotensin-converting enzyme inhibitor angiotensin II receptor blocker combination therapy a case report Sabine Oertelt-Prigione1 Andrea Crosignani 2 Maurizio Gallieni3 Emanuela Vassallo2 Mauro Podda4 and Massimo Zuin2 Abstract Introduction A combination therapy of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers has been used to control proteinuria following initial demonstration of its efficacy. However recently concerns about the safety of this therapy have emerged prompting several authors to urge for caution in its use. In the following case report we describe the occurrence of a serious and unexpected adverse drug reaction after administration of a combination of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers to a patient with nephrotic syndrome and liver cirrhosis with severe portal hypertension. Case presentation We administered this combination therapy to a 40-year-old Caucasian man with liver cirrhosis in our Hepatology Clinic given the concomitant presence of glomerulopathy associated with severe proteinuria. While the administration of one single drug appeared to be well-tolerated our patient developed severe acute encephalopathy after the addition of the second one. Discontinuation of the therapy led to the disappearance of the side-effect. A tentative rechallenge with the same drug combination led to a second episode of acute severe encephalopathy. Conclusion We speculate that this adverse reaction may be directly related to the effect of angiotensin II on the excretion of blood ammonia. Therefore we suggest that patients with liver cirrhosis and portal hypertension are at risk of developing clinically relevant encephalopathy when .
