SHM Converge Scientific Abstract ePoster Gallery-When Antihypertensives Harm: A Case of Supratherapeutic International Normalized Ratio (Inr) Secondary to Olmesartan-Induced Enteropathy

When Antihypertensives Harm: A Case of Supratherapeutic International Normalized Ratio (Inr) Secondary to Olmesartan-Induced Enteropathy

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This case describes an 85-year-old woman with pulmonary embolism/deep venous thrombosis on warfarin, atrial fibrillation, and hypertension who developed 9 weeks of severe watery diarrhea, poor intake, and 45–50 lb weight loss. During this time, her previously stable INR became markedly supratherapeutic, requiring repeated warfarin adjustments. She was evaluated by gastroenterology and then admitted after concern for dyspnea and possible arrhythmia.<br /><br />Her admission labs showed severe coagulopathy and dehydration/renal injury, including INR 26.85, PT 267.3 seconds, PTT 98 seconds, bicarbonate 10 mmol/L, BUN 63 mg/dL, and creatinine 2.7 mg/dL. Infectious stool testing was negative, and CT abdomen/pelvis showed no acute abnormality. Endoscopy revealed scalloped and nodular duodenal mucosa, findings concerning for olmesartan-induced enteropathy. Biopsies showed mild acute erosive duodenitis and no evidence of microscopic colitis or malignancy.<br /><br />Olmesartan, which she had taken for 3 years, was held on admission. Her diarrhea improved rapidly after discontinuation, and her INR normalized with vitamin K supplementation, then remained therapeutic when warfarin was restarted at her home dose. She was discharged off olmesartan with outpatient GI and warfarin follow-up.<br /><br />The case highlights olmesartan-induced enteropathy as a rare but important cause of chronic diarrhea and weight loss. It can mimic celiac disease endoscopically and histologically and may lead to complications such as acute kidney injury and supratherapeutic INR, especially in patients taking warfarin. The report emphasizes the importance of thorough medication reconciliation in hospitalized patients, since identifying and stopping the offending drug can lead to rapid clinical improvement.

Asset Subtitle

Megan N. Minchak

Meta Tag

Author List Drew Stone, Megan N. Minchak

Category Clinical Vignettes

Concept Olmesartan-Induced Enteropathy

Concept Chronic Diarrhea

Concept Duodenal Scalloping

Concept Sprue-like Biopsy Changes

Concept Weight Loss

Distinguished Non-Finalist

Presenter Organization Medical University of South Carolina Department of Internal Medicine

Presenting Author Megan N. Minchak

Track Adult

Keywords

olmesartan-induced enteropathy

chronic diarrhea

weight loss

supratherapeutic INR

warfarin

acute kidney injury

duodenal biopsy

celiac disease mimic

dehydration

atrial fibrillation

Olmesartan-Induced Enteropathy

Chronic Diarrhea

Duodenal Scalloping

Sprue-like Biopsy Changes

Weight Loss