Terlipressin Treatment for Severe Gastric Bleeding Tied to Complications

<"http://www.yourlawyer.com/practice_areas/defective_drugs">Terlipressin has been found to reduce serum sodium levels – a condition known as hyponatremia – when used as a treatment for severe portal-hypertensive bleeding, according to a newly published study. The study is published in the October issue of the journal Hepatology.

Severe portal hypertension is an increase in blood pressure of the (portal) vein between digestive organs and the liver. This increase in pressure contributes to the development of varices, or large veins, that can weaken over time and lead to gastrointestinal bleeding. Cirrhosis and portal vein thrombosis are two of the primary causes of severe portal hypertension.

Terlipressin is commonly used to treat acute variceal bleeding, however its effect on serum sodium is largely unknown. This new study, led by Pere Ginès, MD, from the Hospital Clínic in Barcelona, Spain, included 58 consecutive patients treated with terlipressin for gastrointestinal bleeding due to portal-hypertension. During treatment, a reduction of sodium in the blood was found in 67 percent of patients with 31 percent having a moderate decrease and 36 percent experiencing a marked decrease in serum sodium. Only 19 patients were determined to have no change in serum sodium levels. Further results indicated that patients with a low model for end-stage liver disease (MELD) score and normal or near-normal baseline serum sodium had the highest risk of hyponatremia.

The research team also found that 3 of the 21 patients who had a marked reduction in serum sodium developed neurological manifestations. Two of those patients improved after withdrawal of therapy and administration of hypertonic saline. However, the third patient, who developed a progressive impairment in neurological status leading to coma, did not improve after terlipressin withdrawal and treatment with hypertonic saline. That patient later died due to multiorgan failure.

The study authors advised that serum sodium should be closely monitored in patients being treated with terlipressin for severe portal-hypertensive bleeding. They also cautioned that use of solutions with high sodium content to treat this condition may cause a too rapid recovery of sodium leading to adverse events.

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