A Case of Hyponatraemic Seizure Following Terlipressin Therapy for a Variceal Hemorrhage in a Patient with Liver Cirrhosis

Kim, Jinhee; Kim, Ja Kyung; Mun, So-Yeong; Choi, Chung-Jo; Park, Han-Min; Jeong, Yong-Seol; Kang, Jun Goo

doi:10.3904/kjm.2014.87.3.323

Cited by 1 publication

(2 citation statements)

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“…However, the serum sodium levels and mental status of the patient did not improve before the withdrawal of terlipressin administration despite the administration of 3% hypertonic saline. There have been several reports of cases of hyponatremia with seizure that have rapidly recovered nearly normal sodium levels within a day of the withdrawal of terlipressin [ 7 , 8 , 12 ]. However, Solà et al reported on a patient with severe hyponatremia and seizure who developed an osmotic demyelination syndrome after a very rapid recovery of the serum sodium level secondary to the withdrawal of terlipressin and treatment with hypertonic saline [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, most recent practice guidelines for the management of gastrointestinal bleeding due to portal hypertension recommended that hyponatremia has been occurred in patients under terlipressin therapy, especially in patients with preserved liver function [ 11 ]. We also experienced a case of hyponatremic seizure induced by treatment with standard doses of terlipressin in a 52-year-old female who had isolated gastric variceal bleeding secondary to alcoholic liver cirrhosis [ 12 ]. Therefore, we thought that the development of hyponatremia may be an important side effect in cirrhotic patients with acute variceal bleeding following treatment with terlipressin.…”

Section: Introductionmentioning

confidence: 99%

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Baseline Renal Function Predicts Hyponatremia in Liver Cirrhosis Patients Treated with Terlipressin for Variceal Bleeding

Kim

Jung

Park

et al. 2017

Gastroenterology Research and Practice

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Objectives Terlipressin is safely used for acute variceal bleeding. However, side effects, such as hyponatremia, although very rare, can occur. We investigated the development of hyponatremia in cirrhotic patients who had acute variceal bleeding treated with terlipressin and the identification of the risk factors associated with the development of hyponatremia. Design and Methods This retrospective, case-control study investigated 88 cirrhotic patients who developed hyponatremia and 176 controls that did not develop hyponatremia and were matched in terms of age and gender during the same period following terlipressin administration. Results The overall change in serum sodium concentration and the mean lowest serum sodium concentration were 3.44 ± 9.55 and 132.44 ± 8.78 mEq/L during treatment, respectively. Multivariate analysis revealed that baseline serum sodium was an independent positive predictor, and the presence of baseline serum creatinine, HBV, DM, creatinine, and shock on admission was independent negative predictors of hyponatremia (P < 0.05). Conclusion The presence of HBV, DM, the baseline serum sodium, shock on admission, and especially baseline creatinine may be predictive of the development of hyponatremia after terlipressin treatment. Therefore, physicians conduct vigilant monitoring associated with severe hyponatremia when cirrhotic patients with preserved renal function are treated with terlipressin for variceal bleeding.

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