Lisinopril Insulin

A 30-year-old white man with hypertension, type 1 diabetes mellitus, and hyperlipidemia developed myalgias, nausea, and vomiting, which began 4 days after he started working as a jackhammer operator (52). His medications were lisinopril, aspirin, insulin, and gemfibrozil. Creatine kinase and creatinine, which had previously been respectively mildly raised and normal, were markedly raised, consistent with rhabdomyolysis with acute renal insufficiency. 

The EUCLID study group 1997 The EUCLID study. Randomised, placebo-controUed trial of lisinopril in normotensive patients with insulin-dependent diabetes and normoalbuminuria or microalbiminuria. Lancet 349 1787-1792. 

Mogensen CE, Neidam S, Tikkanen I, Oren S, Viskoper R, Watts RW, et al. Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes the candesartan and lisinopril microalbuminuria (CALM) study. BMJ 2000 321 1440-4,... 

A 49-year-old woman with diabetes and hypertension took a deliberate overdose of 60 tablets containing metformin 500 mg and about 25 tablets of hydrochlorothiazide/lisinopril 12.5/ 20 mg. She was seen and treated within 1 hour. Her pH was 7.18, bicarbonate 6 mmol/1, lactate 9.6 mmol/1, glucose 32 mmol/1, and creatinine 106 (imol/1. Treatment included isotonic saline, sodium bicarbonate, and insulin but 5 hours later her pH was 6.79 and bicarbonate 8.4 mmol/1. Continuous venovenous hemofiltration was begun. Hypotension was treated with noradrenaline, phenylephrine, and then... 

A 46-year-old woman with a 6-year history of diabetes mellitus and previously normal renal function developed anuria, hearing loss, myoclonus, and confusion with hallucinations. She was taking lisinopril, hydrochlorothiazide, furose-mide, atorvastatin, omeprazole, salmeterol/fluti-casone and salbutamol by inhalation, metformin, insulin, oxycodone, alprazolam, ven-lafaxine, and gabapentin 300 mg tds. The gabapentin blood concentration was 17.6 mg/1. All her symptoms improved after one session of hemodialysis and had resolved at the time of discharge 4 days later. 

A 79-year-old man underwent colonic resection for bowel obstruction. He had a history of Parkinson s disease and associated dementia, hypertension, type-2 diabetes and occasional constipation. His current medications included carbidopa-levodopa extended release, lisinopril, furosemide, isophane insulin and polyethylene glycol (as needed for constipation). He was treated with metoclopramide (10 mg i.v., every 6 h) for stimulating gastric motility. After receiving the first three doses of metoclopramide, the patient developed mental deterioration until he became xmre-sponsive, and could not be aroused. An electroencephalogram displayed a pattern of diffuse slowing of the background rhythm, which was consistent with acute metabolic encephalopathy. Metoclopramide was discontinued, and... 

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