# Rehabilitation Case: RAAS Therapy, Potassium, and Angioedema

Airway swelling, symptomatic electrolyte problems, and hemodynamic instability require distinct escalation pathways; preserve useful therapy through coordinated monitoring.

![Infographic: Rehabilitation Case: RAAS Therapy, Potassium, and Angioedema](https://urinenephrology.org/visual-reference/images/pt-raas.png?v=20261003c)

## Identify the exact pathway drug

ACE inhibitor, ARB, and sacubitril/valsartan can improve important cardiac/kidney outcomes while lowering BP and changing potassium or filtration. Record the agent and recent change; “a BP pill” does not identify its transition risks or monitoring needs.

## Lip, tongue, or throat swelling

Possible angioedema is an airway concern. Stop activity and activate urgent assessment; tongue/throat symptoms or breathing difficulty require emergency response. Do not dismiss delayed angioedema because the ACE inhibitor has been used for years.

## Palpitations or a concerning potassium result

Pause exertion and arrange timely medical evaluation, especially with weakness, syncope, ECG concerns, or severe hyperkalemia. Potassium elevation may be silent. Exercise tolerance and a normal appearance do not substitute for the ordered laboratory follow-up.

## Dizziness: assess physiology

Measure BP/pulse and postural response when appropriate; review poor intake, vomiting/diarrhea, diuretics, NSAIDs, and congestion symptoms. Persistent symptomatic hypotension or new oliguria needs prescriber assessment rather than advice to push through the exercise.

## Know the transition safeguard

An ACE inhibitor and sacubitril/valsartan require at least 36 hours separation in either direction. ARNI already contains an ARB, so avoid duplicate ARB therapy. Confirm the written stop/start plan and report discrepancies to the prescribing team.

## Close the safety loop

Give the prescriber drug names, last doses, symptom timing, vitals, and available creatinine/potassium results. Review potassium-containing salt substitutes and pregnancy questions through the clinical team. Resume exercise after stabilization under the revised plan, not after an unsupervised medication experiment.

## Supporting evidence

- [Supporting guideline or source](https://dailymed.nlm.nih.gov/dailymed/getFile.cfm?name=ENTRESTO&setid=000dc81d-ab91-450c-8eae-8eb74e72296f)
- [Supporting guideline or source](https://kdigo.org/wp-content/uploads/2026/04/KDIGO-2024-CKD-Guideline.pdf)
- [Supporting guideline or source](https://www.ukkidney.org/sites/default/files/FINAL%20VERSION%20-%20UKKA%20CLINICAL%20PRACTICE%20GUIDELINE%20-%20MANAGEMENT%20OF%20HYPERKALAEMIA%20IN%20ADULTS%20-%20191223.pdf)

## Source lessons

- [case29 acei arb arni pt](https://urinenephrology.org/2025_UDPA_Lectures_Live/cases/case29_acei_arb_arni_pt.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.