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Case Report | Emergency Medicine | Volume 15 Issue 7, July 2026 | Pages: 132 - 134 | India
When Blood Pressure Pills Turn Deadly: A Telmisartan Tale: A Case of ARB's Induced Hyperkalemia
Abstract: Angiotensin II receptor blockers (ARBs) are cornerstone agents in hypertension management, yet their suppression of aldosterone can mask acute metabolic crises when renal clearing capacity drops. We report an 81-year-old female on daily telmisartan for 20 years without biochemical surveillance. Following a 3-day history of acute watery diarrhea and vomiting, she presented with critical hyperkalemia (7.08mmol/L), severe metabolic acidosis (pH 7.105), an acute-on-chronic renal crisis (creatinine 2.70mg/dL), and an electrocardiogram ECG showing a lethal sine wave pattern. Despite these physiological parameters, she remained conscious and fully conversant (GCS E4V5M6). Immediate treatment with intravenous calcium gluconate stabilized the myocardial membrane and successfully reverted the cardiotoxic rhythm. Subsequent intensive care management with intermittent hemodialysis led to complete metabolic normalization, with her serum potassium stabilizing at 4.0mmol/L by discharge. This case highlights the critical importance of regular metabolic monitoring in geriatric patients on chronic renin-angiotensin-aldosterone system (RAAS) inhibitors, especially during intercurrent volume-depleting illnesses.
Keywords: Telmisartan, Hyperkalemia, Acute Kidney Injury, Angiotensin II receptor blockers, Sine-wave electrocardiogram
How to Cite?: Dr Bharath Kumar, Dr Pooja Verma, Dr Dimpal Tanna, "When Blood Pressure Pills Turn Deadly: A Telmisartan Tale: A Case of ARB's Induced Hyperkalemia", Volume 15 Issue 7, July 2026, International Journal of Science and Research (IJSR), Pages: 132-134, https://www.ijsr.net/getabstract.php?paperid=SR26701210656, DOI: https://dx.doi.org/10.21275/SR26701210656