title: Terlipressin Induced Severe Hyponatremia.
abstract: Terlipressin is a vasopressin analogue used for its vasoconstrictor effect in the treatment of variceal bleeding. Despite its good safety profile compared to vasopressin, some adverse reactions may occur during its use - e.g. hyponatremia. We describe a case of a cirrhotic patient with active variceal bleeding treated during two separate hospitalizations with terlipressin. In both drug treatment periods, severe laboratory hyponatremia developed. After terlipressin discontinuation, mineral disbalance corrected rapidly. Positive dechallenge and rechallenge corresponding to the drug administration schedule confirms the causality between terlipressin administration and hyponatremia. Hyponatremia was preceded with substantial fluid retention in both episodes. In this case report we want to highlight the need for fluid balance monitoring immediately after first terlipressin dose, which may individually predict the patient risk for the development of hyponatremia as other risk factors have rather limited predictive value in real clinical settings.
authors.affiliation: Institute of Pharmacology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic. sima.mart@seznam.cz.
authors.forename: Martin
authors.initials: M
authors.lastname: Šíma
authors.affiliation: 1st Department of Internal Medicine, Na Bulovce Hospital, Prague, Czech Republic.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Pokorný
authors.affiliation: 1st Department of Internal Medicine, Na Bulovce Hospital, Prague, Czech Republic.
authors.forename: František
authors.initials: F
authors.lastname: Paďour
authors.affiliation: Institute of Pharmacology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Ondřej
authors.initials: O
authors.lastname: Slanař
mesh_terms: D000328:Adult; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D006396:Hematemesis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007010:Hyponatremia / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy; D008103:Liver Cirrhosis / Q000150:complications*; D008236:Lypressin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000077585:Terlipressin; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects; D014883:Water-Electrolyte Imbalance / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control
chemical_list: D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin
keywords: Adverse drug reaction; Fluid balance; Hyponatremia; Terlipressin; Vasopressin receptor