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Chronic asymptomatic hyponatraemia following angiotensin receptor blocker-neprilysin inhibitor (ARNi) therapy: a case report
  1. Saeed Rashaad Mohammed1,
  2. Lexley Maureen Pinto Pereira2,
  3. Hughley Hanoman3,
  4. Surujpal Teelucksingh1
  1. 1Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies at St. Augustine, St. Augustine, Trinidad and Tobago
  2. 2Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies at St Augustine, St. Augustine, Trinidad and Tobago
  3. 3Open Heart Programme, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago
  1. Correspondence to Saeed Rashaad Mohammed, The University of the West Indies at St Augustine, Saint Augustine, Trinidad and Tobago; saeedrashaadtt{at}

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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 …

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  • Contributors SRM and HH drafted the work. LPP and ST revised it critically. All authors approved the final version of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not Required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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