title: Risk Factors for Developing Hyponatremia During Terlipressin Treatment: A Retrospective Analyses in Variceal Bleeding.
abstract: OBJECTIVE
  The aim of this study was to evaluate the risk factors and clinical significance of terlipressin-induced hyponatremia.
  
  
  BACKGROUND
  Patients receiving terlipressin treatment frequently develop hyponatremia. However, its clinical significance and risk factors are not fully elucidated.
  
  
  METHODS
  Records of patients treated with terlipressin for variceal bleeding were analyzed. Hyponatremia was defined as a decrease in serum sodium (Na) level of >5 mEq/L from the baseline level; severe hyponatremia as a decrease in serum Na level of >10 mEq/L from the baseline level; and rapid severe hyponatremia as a decrease in serum Na level of >10 mEq/L within 3 days of treatment.
  
  
  RESULTS
  The study involved 151 patients (mean age, 55.1±11.8 y) with male predominance (80.8%). Baseline serum Na and creatinine levels were 137.2±6.1 mEq/L and 0.9±0.4 mg/dL, respectively. Patients were treated with terlipressin for 4.5±1.9 days. Changes in serum Na levels from baseline were 0.4±4.1, -1.1±4.8, -4.0±7.0, -6.5±9.1, and -6.1±11.2 mEq/L, whereas the frequencies of hyponatremia and severe hyponatremia were 13.6%, 30.4%, 50.8%, 63.5%, and 66.9% and 0%, 8.8%, 23.3%, 33.0%, and 38.8% on days 1, 2, 3, 4, and 5 of treatment, respectively. Younger age, lower Child-Pugh score, higher serum Na level, and longer duration of terlipressin treatment were independent risk factors. Rapid severe hyponatremia developed in 29 patients (19.2%); lower body mass index was an additional risk factor in this group. Mortality was not associated with hyponatremia.
  
  
  CONCLUSIONS
  Terlipressin-induced hyponatremia occurred frequently, especially in young patients with good liver function and higher Na level. Caution is required when administering terlipressin to patients with low body mass index.
authors.affiliation: Departments of *Internal Medicine, Division of Gastroenterology and Hepatology †Biostatistics, Korea University College of Medicine, Seoul, Korea.
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Yim
authors.forename: Yeon Seok
authors.initials: YS
authors.lastname: Seo
authors.forename: Chang Ho
authors.initials: CH
authors.lastname: Jung
authors.forename: Tae Hyung
authors.initials: TH
authors.lastname: Kim
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Kim
authors.forename: Bora
authors.initials: B
authors.lastname: Keum
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Hyonggin
authors.initials: H
authors.lastname: An
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Yim
authors.forename: Jong Eun
authors.initials: JE
authors.lastname: Yeon
authors.forename: Yoon Tae
authors.initials: YT
authors.lastname: Jeen
authors.forename: Hong Sik
authors.initials: HS
authors.lastname: Lee
authors.forename: Hoon Jai
authors.initials: HJ
authors.lastname: Chun
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Byun
authors.forename: Soon Ho
authors.initials: SH
authors.lastname: Um
authors.forename: Chang Duck
authors.initials: CD
authors.lastname: Kim
authors.forename: Ho Sang
authors.initials: HS
authors.lastname: Ryu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology; D008236:Lypressin / Q000009:adverse effects / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012964:Sodium / Q000097:blood; D000077585:Terlipressin; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000009:adverse effects*
chemical_list: D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin; D012964:Sodium; D003404:Creatinine