AlKindi Fatima, AlHaj Omar, Alhanaee Amnah, Almazrouei Raya, Boobes Yousef
Division of Internal Medicine, Tawam Hospital, Al Ain, ARE.
Department of Gastroenterology, Tawam Hospital, Al Ain, ARE.
Cureus. 2024 Jul 15;16(7):e64576. doi: 10.7759/cureus.64576. eCollection 2024 Jul.
Terlipressin is an analogue of vasopressin that is indicated as first-line therapy for variceal hemorrhage and hepatorenal syndrome. Hyponatremia is an uncommon complication of terlipressin because it has less effect on vasopressin V2 receptors located in the kidneys. Profound hyponatremia related to terlipressin use is a rare complication that needs to be aware of. We described a 35-year-old previously healthy man, who was admitted for esophageal variceal bleeding that was attributed to hepatitis B-related liver cirrhosis. He had a normal baseline sodium level (Na 139 mmol/L) and developed severe hyponatremia 119 mmol/L (euvolemic, hypo-osmolar) at 72 hours of terlipressin therapy. After holding the medication, the hyponatremia corrected rapidly to 135 mmol/L within 24 hrs. Terlipressin was given again as therapy for overcorrection of hyponatremia and the sodium level decreased before being stabilized without neurological consequences. Severe hyponatremia is an uncommon complication of terlipressin therapy; however, our case emphasizes the importance of sodium monitoring during terlipressin therapy in all patients to prevent this complication, and more importantly, to avoid rapid correction that could happen after holding it.
特利加压素是一种血管加压素类似物，被用作治疗静脉曲张出血和肝肾综合征的一线药物。低钠血症是特利加压素一种不常见的并发症，因为它对位于肾脏的血管加压素V2受体影响较小。与使用特利加压素相关的严重低钠血症是一种罕见的并发症，需要引起注意。我们描述了一名35岁既往健康的男性，因乙型肝炎相关肝硬化导致的食管静脉曲张出血入院。他的基线钠水平正常（钠139 mmol/L），在特利加压素治疗72小时时出现严重低钠血症，血钠水平为119 mmol/L（血容量正常，低渗性）。停用药物后，低钠血症在24小时内迅速纠正至135 mmol/L。由于低钠血症过度纠正，再次给予特利加压素治疗，血钠水平在稳定前下降，但未出现神经系统后果。严重低钠血症是特利加压素治疗一种不常见的并发症；然而，我们的病例强调了在所有接受特利加压素治疗的患者中监测血钠的重要性，以预防这种并发症，更重要的是，避免在停药后可能发生的快速纠正。
