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ACE Inhibitors Toxicity - Causes, Effects, Symptoms, Diagnosis, and Treatment.

Creator: Dr. Osheen Kour
Published: 2023-01-31T11:59:09

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ACE inhibitor overdose in the body can lead to toxicity, causing severe hypotension, which can be fatal sometimes. Read the article to know more about it.

Written by

Dr. Osheen Kour

Medically reviewed by

Dr. Basuki Nath Bhagat

January 31, 2023

February 23, 2024

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Contents

What Are the Examples of ACE Inhibitor Drugs Used?
What Are the Uses of ACE Inhibitors?
What Are the Side Effects of ACE Inhibitors?
What Are the Symptoms Produced Due to ACE Inhibitor Overdose?
How Is ACE Inhibitor Toxicity Diagnosed?
What Are the Treatment Options for Ace Inhibitor Toxicity?
What Are the Contraindications for ACE Inhibitor Drugs?

Introduction

Angiotensin-converting enzymes (ACE) inhibitors are used to lower the blood pressure in the body by relaxing the veins, and arteries.ACE inhibitors inhibit the enzyme in body to release angiotensin II as it narrows the blood vessels, thus, increasing blood pressure. Angiotensin II also causes high blood pressure by releasing some hormones. ACE inhibitors can produce mild toxicity in some cases due to therapeutic dose intake. Some severe toxic effects occur only if the drug is co-ingested or taken accidentally by young children. The drug does not have any antidotal treatment; thus, proper medical management can treat the condition depending on the intoxication levels and effects. ACE inhibitor drugs are usually taken orally except enalapril, which is given through the intravenous route.

What Are the Examples of ACE Inhibitor Drugs Used?

Enalapril.
Benazepril.
Captopril.
Ramipril.
Lisinopril.
Fosinopril.
Perindopril.
Trandolapril.

What Are the Uses of ACE Inhibitors?

ACE inhibitors are used to treat various medical conditions, such as:

Hypertension (High Blood Pressure)- The drug can treat hypertension by reducing arterial, systolic, and diastolic blood pressure and belongs to the top four drug categories for treating hypertension in adults.
Heart Failure- ACE inhibitor also treats heart failure by reducing the stress on systolic walls and also lowers the preload and afterload. This helps in regulating the heart rate by increasing the overall cardiac output. The drug is recommended for treating heart failure conditions.
Diabetes- These drugs can also treat hypertension in diabetic people because they help improve heart functioning, reduce neuropathy related to diabetes mellitus, and minimize the risk of myocardial infarction.
Chronic Kidney Disease- ACE inhibitors are also considered the first line of drugs for chronic kidney disorders. The medicine helps decrease the levels of proteinuria in the body and inhibits the further progression of kidney disease.
Glomerular Disease- ACE inhibitors can also treat glomerular diseases by maintaining the proteinuria and glomerular filtration rate

Scleroderma (hardening of the connective tissues and skin).

What Are the Side Effects of ACE Inhibitors?

Side effects produced by ACE inhibitors include:

Physical symptoms include chest pain, fever, sore throat, irregular heartbeats.
Lightheadedness, frequent fainting, and drowsiness during initial dose intake are common in patients with frequent hypotension.
Angioedema or swelling in the feet and legs is also present due to fluid accumulation and bradykinin. Enalapril ACE inhibitors usually produce this effect.
Skin redness and itching.
Hyperkalemia also occurs because ACE inhibitors decrease the aldosterone level in the body, which helps in the excretion of potassium via urine.
Cough is the most common side effect of ACE inhibitors caused due to inflammatory compounds such as bradykinin.
Jaundice is a severe drug effect that can lead to hepatic necrosis or even death.
The metallic or salty taste subsides after taking medicine continuously.
Potassium levels can also increase, which can be fatal sometimes. A person may feel symptoms like a tingling sensation or numbness in the feet, lips, and hands, irregular heartbeats, confusion, breathlessness, and weakness due to high potassium levels in the blood.
ACE inhibitors can cause kidney failure in some cases.
Severe vomiting can also be caused, which leads to dehydration and further decreases blood pressure levels.

What Are the Symptoms Produced Due to ACE Inhibitor Overdose?

ACE inhibitor overdose cases are sporadic and can produce symptoms such as:

Hypotension.
Hyperkalemia.
Metabolic acidosis.
Renal impairment.

How Is ACE Inhibitor Toxicity Diagnosed?

Toxicity caused by ACE inhibitors is very mild to moderate and can be diagnosed by:

Exposure history of the person, amount of ingestion, and present symptoms.
Testing the creatinine, glucose, and electrolyte levels in the body.
Blood tests usually are different from clinical effects and not used very often to make the diagnosis.

What Are the Treatment Options for Ace Inhibitor Toxicity?

A doctor can do Initial management by providing supportive care and monitoring vitals for at least 6 hours after drug ingestion.
In case of hypotension caused due to drug overdose, make the person lie down in a supine position with intravenous fluids administered.
A causative agent (ACE inhibitor) should be discontinued immediately and must give the treatment for angioedema.
Treatment for hyperkalemia is also given in some cases if it occurs.
Decontamination with activated charcoal can be done for mild sedatives, or else gastric lavage can help treat severe intoxication.
Hemodialysis is not advised in such cases.

What Are the Contraindications for ACE Inhibitor Drugs?

ACE inhibitors can affect the circulatory system and thus interacts with other drugs in the following ways:

Avoid non-steroidal anti-inflammatory drugs (NSAIDs) with ACE inhibitors because they can cause water and sodium retention, thus, making ACE inhibitors less effective.
Do not take any salt substitute with ACE inhibitors because they can lead to potassium retention in the body.
ACE inhibitors are contraindicated in pregnancy as they can lower blood pressure, increase potassium retention, and cause kidney failure in pregnant women.
Potassium supplements must not be taken with ACE inhibitors.
The drug should not be given to those Hypersensitive to ACE inhibitors.
An ACE inhibitor must not be prescribed if a person is already taking any renin inhibitor.
Renal impairment.
Cardiac output obstructions.

Conclusion

ACE inhibitors help treat medical conditions like diabetes, myocardial infarction, and heart failure and are also the first line of the drug in hypertensive conditions. The drug rarely causes toxicity but can lead to mild to moderate side effects due to its accidental or medical overdose. However, these effects can be neutralized or treated with immediate medical interventions that are generally life-saving. But in case of adverse drug events and breach of contraindication, ACE inhibitors can be fatal in various conditions like pregnancy, liver disorders, and kidney diseases. Therefore, the drug must be consumed after a doctor’s consultation and in the prescribed dosage for safety reasons.

Frequently Asked Questions

1. Which Category of Medications Hinders Enzymes from Transforming Angiotensin 1 into Angiotensin 2?

Medications belonging to the category of angiotensin-converting enzyme inhibitors (ACE inhibitors) impede the action of enzymes responsible for converting angiotensin 1 into angiotensin 2. By blocking this conversion, ACE inhibitors help regulate blood pressure and fluid balance in the body, making them valuable tools in managing conditions like hypertension and heart failure.

2. What Is the Function of Angiotensin Converting Enzymes?

Angiotensin-converting enzymes (ACE) facilitate the conversion of angiotensin 1, an inactive form, into angiotensin 2, an active hormone. Angiotensin 2 plays a crucial role in regulating blood pressure by constricting blood vessels and stimulating the release of aldosterone, affecting fluid and electrolyte balance. Additionally, angiotensin 2 triggers the release of certain hormones that impact the cardiovascular system. Understanding the role of ACE is essential in developing treatments for conditions related to blood pressure and cardiovascular health.

3. Which Angiotensin Converting Enzymes Have Not Been Subjected to Recalls?

The specific angiotensin-converting enzymes that have not been subjected to recalls effectively contribute to regulating the renin-angiotensin system and converting angiotensin 1 to angiotensin 2. These enzymes maintain blood pressure, fluid balance, and overall cardiovascular health. Any potential recall of these enzymes could disrupt their physiological functions and impact patients with hypertension and heart failure who rely on their proper functioning for effective treatment.

4. How Do Medications Ending With "Inhibitors" Affect Angiotensin Converting Enzymes?

Medications ending with "inhibitors" influence angiotensin-converting enzymes by blocking their activity. These inhibitors specifically target the conversion of angiotensin 1 to angiotensin 2, significantly affecting blood pressure regulation and fluid balance. These medications help relax blood vessels, reduce fluid retention, and ultimately lower blood pressure by inhibiting this conversion. This mechanism makes ACE inhibitors a valuable treatment option for individuals with hypertension and heart failure, as they help restore a healthier cardiovascular balance.

5. What Is the Reason Behind Angiotensin Converting Enzymes' Ability to Constrict Blood Vessels?

The ability of angiotensin-converting enzymes (ACE) to constrict blood vessels is attributed to the action of their product, angiotensin 2. ACE plays a pivotal role in converting angiotensin 1 to angiotensin 2, a potent vasoconstrictor. Angiotensin 2 causes blood vessels to narrow by promoting the contraction of smooth muscle cells in their walls. This vasoconstrictive effect increases blood pressure and plays a key role in regulating blood flow distribution throughout the body.

6. What Role Do Angiotensin Converting Enzymes Play in the Body?

Angiotensin-converting enzymes (ACE) play a significant role in the body's renin-angiotensin-aldosterone system, a vital regulatory mechanism for blood pressure and fluid balance. ACE is primarily responsible for converting angiotensin 1, an inactive precursor, into angiotensin 2, an active hormone. Angiotensin 2 affects blood vessels' constriction, stimulates the release of aldosterone to regulate salt and water balance, and influences the release of other hormones that impact cardiovascular function. By modulating these processes, ACE contributes to the overall control of blood pressure and fluid equilibrium in the body.

7. Is Angiotensinogen an Enzyme or a Hormone?

Angiotensinogen is a precursor protein produced by the liver and released into the bloodstream. It is not an enzyme but rather a protein that serves as the starting point for the production of angiotensin. This precursor is acted upon by renin, an enzyme produced by the kidneys, to initiate the cascade that eventually leads to the formation of angiotensin 1. Angiotensin 1 is then further converted into angiotensin 2 by angiotensin-converting enzymes (ACE), and it is angiotensin 2 that plays a key role in regulating blood pressure and fluid balance in the body.

8. Which Enzyme Facilitates the Conversion of Angiotensinogen?

An enzyme known as renin facilitates the conversion of angiotensinogen to angiotensin 1. Renin is produced and released by specialized kidney cells called juxtaglomerular cells. When the body's blood pressure drops or there is a decrease in fluid volume, these cells release renin into the bloodstream. Renin then acts on angiotensinogen, a precursor protein produced by the liver, leading to the formation of angiotensin 1. This step is crucial to the renin-angiotensin-aldosterone system, pivotal in regulating blood pressure and fluid balance.

9. Does Angiotensin Act as a Vasodilator?

Angiotensin itself is not a vasodilator; instead, it acts as a vasoconstrictor. Angiotensin 2, formed through the action of angiotensin-converting enzymes (ACE), primarily functions as a potent vasoconstrictor. It causes blood vessels to narrow by stimulating the contraction of smooth muscle cells in their walls. This vasoconstrictive effect leads to increased resistance in the blood vessels and, subsequently, an elevation in blood pressure. While angiotensin 2 is essential to the body's blood pressure regulation, its primary role is to constrict blood vessels rather than dilate them.

10. Does Angiotensin Contribute to an Increase in Blood Pressure?

Yes, angiotensin does contribute to an increase in blood pressure. Angiotensin 2, formed through the action of angiotensin-converting enzymes (ACE), has a vasoconstrictive effect on blood vessels. This means that it causes the blood vessels to narrow, leading to increased resistance to blood flow and subsequently elevating blood pressure. Additionally, angiotensin 2 stimulates the release of aldosterone, a hormone that promotes sodium and water retention in the kidneys, further contributing to higher blood pressure. Overall, the actions of angiotensin play a crucial role in maintaining blood pressure within the body.

11. What Is the Primary Function of the Angiotensin Converting Enzyme?

The primary function of the angiotensin-converting enzyme (ACE) is to catalyze the conversion of angiotensin 1, an inactive precursor molecule, into angiotensin 2, an active hormone. Angiotensin 2 is a potent vasoconstrictor that narrows blood vessels, increasing blood pressure. Additionally, angiotensin 2 stimulates the release of aldosterone, a hormone that affects sodium and water balance in the body. ACE inhibitors, which block the action of ACE, are commonly used medications to manage conditions like hypertension and heart failure, as they reduce the formation of angiotensin 2 and help regulate blood pressure and fluid balance.

12. Where Does the Body Produce Angiotensin-Converting Enzyme?

Angiotensin-converting enzyme (ACE) is produced primarily in the endothelial cells, which are the cells that line the blood vessels, especially in the lungs. These cells are found in the lungs' capillaries, where they play a crucial role in regulating blood pressure and fluid balance. The presence of ACE in the lungs is significant because it allows for the conversion of angiotensin 1 to angiotensin 2 in this location. Angiotensin 2 then acts on blood vessels to regulate constriction and influence cardiovascular function.

13. How Do Inhibitors of Angiotensin Convert Enzyme Function?

Inhibitors of angiotensin-converting enzymes (ACE) work by blocking the activity of ACE, which is responsible for converting angiotensin 1 to angiotensin 2. By inhibiting this conversion, these medications reduce the levels of angiotensin 2 in the body. This leads to vasodilation, a widening of blood vessels, and a decrease in the release of aldosterone, a hormone that promotes water and sodium retention. As a result, blood vessels relax, blood pressure is lowered, and the workload on the heart is reduced. ACE inhibitors are commonly prescribed to manage hypertension, heart failure, and certain kidney disorders.

14. Why Is Angiotensin-Converting Enzyme Present in the Lungs?

Angiotensin-converting enzyme (ACE) is present in the lungs due to its crucial role in the local regulation of blood pressure and fluid balance within the pulmonary circulation. The enzyme's activity in the lungs converts angiotensin 1 to angiotensin 2 within the pulmonary blood vessels. This process helps regulate the constriction of blood vessels and maintains appropriate blood flow and pressure in the lungs. The local presence of ACE in the lungs demonstrates its specific role in modulating the cardiovascular system's functions in this vital organ.

Sources

Dr. Basuki Nath Bhagat

Family Physician

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