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Side Effects and Adverse Events Associated With Intravenous Angiotensin II in Humans: A Systematic Review and Meta-analysis FREE TO VIEW

Divya Chalikonda; Laurence Busse, MD; David Yoo; Lakhmir Chawla, MD
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Inova Fairfax Medical Center, Falls Church, VA

Chest. 2015;148(4_MeetingAbstracts):348A. doi:10.1378/chest.2268700
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SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Angiotensin II (ATII) is a naturally occurring hormone with important endocrine effects. It has recently been evaluated in a prospective randomized controlled trial for the treatment of high output shock. ATII has been administered to patients with a variety of medical conditions, and has only been shown to exacerbate one underlying disease, asthma. To date, however, there has been no effort to systematically review the side effects or adverse events associated with intravenous ATII.

METHODS: We performed a comprehensive literature search of the administration of intravenous ATII to humans. Keywords included “intravenous administration, intravenous Injection, intravenous infusion, and angiotensin II.” We identified all studies which reported physiologic effects associated with the administration of ATII. Side effects were defined as physiological effects that were unintended or incongruous with the pressor effect of ATII. Adverse events were defined as deaths or serious morbidities that were attributable to ATII.

RESULTS: 1193 studies were screened. 171 studies (3,291 participants) reported physiologic effects associated with ATII. The most commonly cited side effects included hyperaldosteronism and other disturbances of the renin-angiotensin-aldosterone (RAA) axis (40 studies), altered renal function (32 studies), other endocrine abnormalities (27 studies), and electrolyte disturbances (17 studies). Cardiac side effects were mentioned in 14 studies. The most serious side effect was bronchoconstriction or asthma, which was reported in 3 studies. Doses were reported most commonly in ng/kg/min with a range of 1 to 800 ng/kg/min (mean: 3.36 ± 6.62 ng/kg/min to 12.16 ± 16.84 ng/kg/min. No deaths or serious adverse events attributable to ATII were reported, though 23 patients in whom ATII was used to treat catecholamine-resistant septic shock died of their shock. Significant heterogeneity in study design prevented meta-analysis of results.

CONCLUSIONS: The incidence of side effects associated with ATII is uncommon, and side effects are generally mild, with exacerbation of asthma being the most serious. The most commonly observed side effects were derangements with the RAA axis, kidney function and other endocrine abnormalities.

CLINICAL IMPLICATIONS: Prospective, randomized controlled trials of the therapeutic use of ATII (at a dose range of 1ng/kg/min to 20ng/kg/min) as a pressor in catecholamine-resistant shock are ongoing. The analysis contained herein supports the idea that ATII may safely be studied in humans.

DISCLOSURE: The following authors have nothing to disclose: Divya Chalikonda, Laurence Busse, David Yoo, Lakhmir Chawla

Angiotensin II is being evaluated as a novel pressor agent for use in catecholamine resistant shock. This will be mentioned in my presentation adjunctively, though this is not the main point of my research.




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