Endocrine Abstracts

Background: Terlipressin is a vasopressin agonist used in acute variceal bleeding due to its effect on vasopressin V1 receptors, causing splanchic vasoconstriction. Although it has good safety profile, it has been shown to act as partial agonist of V2 receptors but its effects on serum sodium concentration can be variable.

Case Presentation: 58 year old lady was admitted after banding for variceal bleed found at routine screening. She was started on terlipressin, antibiotics and admitted for monitoring. Hemoglobin continued to dropped and she was scoped again and found a bleeding varix and was banded. On day 3, her sodium level started dropping, coming down to 128 mmol/l from 140 mmol/l at admission. Over next 48 h, it further dropped to 116 mmol/l despite halving the dose of terlipressin. She was euvolemic on examination with a urinary sodium of 209, urinary osmolarity 598 and serum osmolarity 252. She became symptomatic, was given hypertonic saline, and started on fluid restriction. Terlipressin was withdrawn with sodium level returning back to 135 mmol/l over next 48 h. She was observed as an inpatient for sodium level and further bleeding for 2 days and then discharged after remaining stable during the observation period.

Conclusions: Acute hyponatremia can develop during treatment with terlipressin for portal-hypertensive bleeding, can develop rapidly and usually reversible with cessation of therapy.