Hyponatremia in Terlipressin-treated patients with gastrointestinal bleeding secondary to portal hypertension

Abstract

To study the effects of Terlipressin on blood sodium concentrations in individuals with acute portal hypertensive haemorrhage. The observational study was conducted on 34 patients divided in two groups. The two groups were compared for efficacy, safety, overall survival and length of hospital stay. Terlipressin was administered to all of the patients for five days and the observations with respect to the blood sodium level were recorded and analyzed. Twenty-nine male and five female patients were enrolled during the study. All the patients had a Mean Arterial Pressure (MAP) < 90 mmHg and in 30 patients, vital scores such as Child-Turcotte-Pugh or Child-Pugh (CTP) scores with CTP-B of n=10, CTP-C of n=22, and Model for End-stage Liver Disease (MELD) >10 indicated that they had poor liver function. Twenty-two patients exhibited symptoms of moderate to severe ascites. The average sodium levels were 127.6 ± 1 meq/dl and 123.4 ± 0.7 meq/dl on day one and day five, respectively. The mean sodium level drop was noted to be 4.2 ± 0.5 meq/dl which was statistically significant (p<0.05) over the five days duration of study. A greater decline was observed in patients with high initial sodium, CTP-A and a lower MELD score. Additionally, any critical neurological or other adverse events were not noticed. Till tapering and discontinuation of Terlipressin, all patients were treated successfully, discontinuation is not required. With better hepatic function, significant blood sodium level reduction was noted. Ascites, low MAP, and other medications were also found to be contributing factors. More Randomized Controlled Trials (RCTs) are necessary to define the precise role of Terlipressin in hyponatremia.