{"id":"https://openalex.org/W4411006331","doi":"https://doi.org/10.15605/jafes.040.s1.059","title":"WHEN TREATMENT BACKFIRES: SEVERE HYPOTONIC HYPONATREMIA INDUCED BY ANGIOTENSIN RECEPTOR BLOCKERS","display_name":"WHEN TREATMENT BACKFIRES: SEVERE HYPOTONIC HYPONATREMIA INDUCED BY ANGIOTENSIN RECEPTOR BLOCKERS","publication_year":2025,"publication_date":"2025-05-30","ids":{"openalex":"https://openalex.org/W4411006331","doi":"https://doi.org/10.15605/jafes.040.s1.059"},"language":"en","primary_location":{"id":"doi:10.15605/jafes.040.s1.059","doi":"https://doi.org/10.15605/jafes.040.s1.059","is_oa":true,"landing_page_url":"https://doi.org/10.15605/jafes.040.s1.059","pdf_url":"https://asean-endocrinejournal.org/index.php/JAFES/article/download/5357/4535","source":{"id":"https://openalex.org/S2737532273","display_name":"Journal of the ASEAN Federation of Endocrine Societies","issn_l":"0857-1074","issn":["0857-1074","2308-118X"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-c","medline","poland-20","russia-white-list-4"],"host_organization":"https://openalex.org/P4310319565","host_organization_name":"ASEAN Federation of Endocrine Societies","host_organization_lineage":["https://openalex.org/P4310319565"],"host_organization_lineage_names":["ASEAN Federation of Endocrine Societies"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of the ASEAN Federation of Endocrine Societies","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"diamond","oa_url":"https://asean-endocrinejournal.org/index.php/JAFES/article/download/5357/4535","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5117820410","display_name":"Najihah Husain","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Najihah Husain","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"last","author":{"id":"https://openalex.org/A5008726792","display_name":"Marisa Khatijah Borhan","orcid":"https://orcid.org/0000-0003-4053-0930","observed_orcids":["https://orcid.org/0000-0003-4053-0930"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Marisa Khatijah Borhan","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]}],"institutions":[],"countries_distinct_count":0,"institutions_distinct_count":0,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"40","issue":"S1","first_page":"37","last_page":"38"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11967","display_name":"Electrolyte and hormonal disorders","score":0.9990000128746033,"subfield":{"id":"https://openalex.org/subfields/2727","display_name":"Nephrology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11967","display_name":"Electrolyte and hormonal disorders","score":0.9990000128746033,"subfield":{"id":"https://openalex.org/subfields/2727","display_name":"Nephrology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11001","display_name":"Renin-Angiotensin System Studies","score":0.00039999998989515007,"subfield":{"id":"https://openalex.org/subfields/2705","display_name":"Cardiology and Cardiovascular Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10144","display_name":"Blood Pressure and Hypertension Studies","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2705","display_name":"Cardiology and Cardiovascular Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/valsartan","display_name":"valsartan","score":0.9769999980926514},{"id":"https://openalex.org/keywords/angiotensin-receptor-blockers","display_name":"angiotensin receptor blockers","score":0.9850000143051147},{"id":"https://openalex.org/keywords/drug-induced-hyponatremia","display_name":"drug-induced hyponatremia","score":0.925000011920929},{"id":"https://openalex.org/keywords/hypotonic-hyponatremia","display_name":"hypotonic hyponatremia","score":0.9919999837875366},{"id":"https://openalex.org/keywords/hyperkalemia","display_name":"hyperkalemia","score":0.8999999761581421},{"id":"https://openalex.org/keywords/thiazide-diuretics","display_name":"thiazide diuretics","score":0.8149999976158142},{"id":"https://openalex.org/keywords/renal-sodium-reabsorption","display_name":"renal sodium reabsorption","score":0.6909999847412109},{"id":"https://openalex.org/keywords/adverse-drug-reactions","display_name":"adverse drug reactions","score":0.7929999828338623},{"id":"https://openalex.org/keywords/elderly-patients","display_name":"elderly patients","score":0.7160000205039978},{"id":"https://openalex.org/keywords/hypertension","display_name":"hypertension","score":0.5210000276565552}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9540106058120728},{"id":"https://openalex.org/C556039675","wikidata":"https://www.wikidata.org/wiki/Q771035","display_name":"Traditional medicine","level":1,"score":0.32551324367523193}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.15605/jafes.040.s1.059","doi":"https://doi.org/10.15605/jafes.040.s1.059","is_oa":true,"landing_page_url":"https://doi.org/10.15605/jafes.040.s1.059","pdf_url":"https://asean-endocrinejournal.org/index.php/JAFES/article/download/5357/4535","source":{"id":"https://openalex.org/S2737532273","display_name":"Journal of the ASEAN Federation of Endocrine Societies","issn_l":"0857-1074","issn":["0857-1074","2308-118X"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-c","medline","poland-20","russia-white-list-4"],"host_organization":"https://openalex.org/P4310319565","host_organization_name":"ASEAN Federation of Endocrine Societies","host_organization_lineage":["https://openalex.org/P4310319565"],"host_organization_lineage_names":["ASEAN Federation of Endocrine Societies"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of the ASEAN Federation of Endocrine Societies","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.15605/jafes.040.s1.059","doi":"https://doi.org/10.15605/jafes.040.s1.059","is_oa":true,"landing_page_url":"https://doi.org/10.15605/jafes.040.s1.059","pdf_url":"https://asean-endocrinejournal.org/index.php/JAFES/article/download/5357/4535","source":{"id":"https://openalex.org/S2737532273","display_name":"Journal of the ASEAN Federation of Endocrine Societies","issn_l":"0857-1074","issn":["0857-1074","2308-118X"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-c","medline","poland-20","russia-white-list-4"],"host_organization":"https://openalex.org/P4310319565","host_organization_name":"ASEAN Federation of Endocrine Societies","host_organization_lineage":["https://openalex.org/P4310319565"],"host_organization_lineage_names":["ASEAN Federation of Endocrine Societies"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of the ASEAN Federation of Endocrine Societies","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","score":0.9907000064849854,"id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Case Report","id":"https://openalex.org/study-designs/case-report"}],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W4411006331.pdf","grobid_xml":"https://content.openalex.org/works/W4411006331.grobid-xml"},"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W2048553997","https://openalex.org/W2914407283","https://openalex.org/W2040348921","https://openalex.org/W4413876005","https://openalex.org/W2119990624","https://openalex.org/W7099349632","https://openalex.org/W2164933570","https://openalex.org/W85728467","https://openalex.org/W3201751573","https://openalex.org/W2038339058"],"abstract_inverted_index":{"INTRODUCTION/BACKGROUND":[0],"Angiotensin":[1],"receptor":[2],"blockers":[3],"(ARBs)":[4],"are":[5],"commonly":[6],"used":[7],"antihypertensive":[8],"medications.":[9,176],"ARBs":[10,243],"may":[11],"cause":[12],"worsening":[13],"of":[14,30,73,152,213],"renal":[15,20,257],"function":[16],"and":[17,110,134,149,180,201,231,234,269],"hyperkalemia,":[18],"necessitating":[19],"profile":[21],"monitoring":[22],"after":[23,87,98],"their":[24],"initiation.":[25],"We":[26],"report":[27],"a":[28,71,146],"case":[29],"severe":[31,115,214,247],"hypotonic":[32,116,215,285],"hyponatremia":[33,117,216,248,278,286],"in":[34,266,282],"an":[35,88],"elderly":[36,268],"patient":[37],"who":[38],"was":[39,51,144,166,220,236],"started":[40],"on":[41,271],"valsartan.":[42],"CASE":[43],"A":[44],"70-year-old":[45],"Malay":[46],"female":[47],"with":[48,108,284],"underlying":[49],"hypertension":[50],"recently":[52],"prescribed":[53],"valsartan":[54,219],"80":[55],"mg":[56],"OD":[57],"by":[58,249],"her":[59,159,225],"primary":[60],"care":[61],"(PC)":[62],"doctor":[63],"for":[64],"blood":[65,178,181],"pressure":[66,179],"optimization.":[67],"Notably,":[68],"she":[69,101,143,235],"had":[70,82],"history":[72],"adrenal":[74,189],"insufficiency":[75,190],"secondary":[76,217],"to":[77,103,156,218,246],"exogenous":[78],"steroid":[79],"use":[80],"but":[81],"successfully":[83],"discontinued":[84],"oral":[85],"hydrocortisone":[86],"adequate":[89],"Synacthen":[90],"test":[91],"response":[92],"2":[93],"years":[94],"ago.":[95],"Four":[96],"days":[97,240],"starting":[99,157],"valsartan,":[100,158,224],"presented":[102],"the":[104,141,163,211,228,251,267],"Emergency":[105],"Department":[106],"(ED)":[107],"dizziness":[109],"vomiting.":[111],"Laboratory":[112],"results":[113],"revealed":[114],"(serum":[118,136],"sodium":[119,161,230,259],"110":[120],"mmol/L,":[121],"serum":[122,160,197,229],"osmolality":[123,127],"259":[124],"mOsm/kg,":[125,129],"urine":[126,130],"247":[128],"Na":[131],"71":[132],"mmol/L)":[133],"hyperkalemia":[135],"potassium":[137,232],"7.0":[138],"mmol/L).":[139],"In":[140],"ED,":[142],"given":[145],"lytic":[147],"cocktail":[148],"150":[150],"cc":[151],"3%":[153],"saline.":[154],"Prior":[155],"at":[162],"PC":[164],"clinic":[165],"135":[167],"mmol/L.":[168],"She":[169],"denied":[170],"using":[171],"any":[172],"over-the-counter":[173],"or":[174],"traditional":[175],"Her":[177],"glucose":[182],"levels":[183],"were":[184,208],"normal":[185],"throughout":[186],"hospitalization,":[187],"making":[188],"less":[191],"likely.":[192],"Further":[193],"investigations,":[194],"including":[195],"morning":[196],"cortisol":[198],"(500.4":[199],"nmol/L)":[200],"TSH":[202],"(0.54":[203],"mIU/L,":[204],"NR":[205],"0.4\u20134.0":[206],"mIU/L),":[207],"normal.":[209],"Thus,":[210],"diagnosis":[212],"made.":[221],"After":[222],"withholding":[223],"symptoms":[226],"resolved,":[227],"normalized,":[233],"discharged":[237],"well":[238],"4":[239],"later.":[241],"CONCLUSION":[242],"can":[244],"lead":[245],"blocking":[250],"angiotensin":[252],"II":[253],"receptor,":[254],"which":[255],"inhibits":[256],"tubular":[258],"reabsorption.":[260],"This":[261],"effect":[262],"is":[263],"particularly":[264],"pronounced":[265],"individuals":[270],"concomitant":[272],"thiazide":[273],"therapy.":[274],"Although":[275],"rare,":[276],"ARB-associated":[277],"should":[279],"be":[280],"considered":[281],"patients":[283],"when":[287],"other":[288],"causes":[289],"have":[290],"been":[291],"ruled":[292],"out.":[293]},"counts_by_year":[],"updated_date":"2026-11-12T12:28:57.059296","created_date":"2025-10-10T00:00:00"}