Terlipressin treatment for gastrointestinal bleeding reduces serum sodium

September 22, 2010

A new study published in the October issue of the journal Hepatology found that patients with severe portal-hypertensive bleeding who are treated with terlipressin may experience an acute reduction of sodium in their blood. This reduction in serum sodium, known as hyponatremia, can cause adverse reactions such as neurological complications, and is rapidly reversible upon terlipressin withdrawal. Researchers suggest that serum sodium should be closely monitored in these patients and caution that use of solutions with high sodium content to treat this condition may cause a too rapid recovery of sodium leading to adverse events.

Cirrhosis and portal vein thrombosis are two of the primary causes of severe portal hypertension--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. Terlipressin is commonly used to treat acute variceal bleeding, however its effect on serum sodium is largely unknown and the focus of the current retrospective study, led by Pere Ginès, MD, from the Hospital Clínic in Barcelona, Spain.

The study included 58 consecutive patients treated with terlipressin for gastrointestinal bleeding due to portal-hypertension. Median age of participants was 54 years, with 77% of the cohort being male and 22% female. Initially patients were treated with somatostatin, but switched to terlipressin due to uncontrolled bleeding or rebleeding in 57% and 43% of cases, respectively.

Researchers noted a significant reduction in serum sodium concentration during terlipressin treatment (from 134.9 at baseline to 130.5 mEq/L at day 5 of treatment). A reduction of sodium in the blood was found in 67% of patients with 31% having a moderate decrease (5-10 mEq/L) and 36% experiencing a marked decrease in serum sodium (greater than 10mEq/L). Only 19 patients were determined to have no change in serum sodium levels.

Further results indicate 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 reduction in serum sodium concentration, common in terlipressin therapy, develops rapidly after onset of treatment, said Dr. Ginès. "In some patients hyponatremia can be severe, leading to neurological complications which usually resolve upon withdrawl from treatment."

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

"In patients with high risk of reduction in serum sodium levels (low MELD scores and normal or near-normal baseline serum sodium concentration), serum sodium concentration should be monitored closely during treatment and terlipressin stopped if hyponatremia develops. Hypotonic fluids should probably be avoided to prevent a further reduction in serum sodium concentration," concluded Dr. Ginès. "Physicians should be aware of our findings in order to prevent the possible neurological complications related to acute hyponatremia or rapid recovery of serum sodium levels."
-end-
Article: "Hyponatremia in Patients Treated with Terlipressin for Severe Gastrointestinal Bleeding due to Portal Hypertension." Elsa Solà, Sabela Lens, Mónica Guevara, Marta Martín-Llahí, Claudia Fagundes, Gustavo Pereira, Marco Pavesi, Javier Fernández, Juan González-Abraldes, Angels Escorsell, Antoni Mas, Jaume Bosch, Vicente Arroyo, and Pere Ginès. Hepatology; Published Online: August 5, 2010 (DOI: 10.1002/hep.23893); Print Issue Date: October 2010. http://onlinelibrary.wiley.com/doi/10.1002/hep.23893/abstract

These studies are published in Hepatology. Media wishing to receive a PDF of the articles may contact healthnews@wiley.com.

Hepatology is the premier publication in the field of liver disease, publishing original, peer-reviewed articles concerning all aspects of liver structure, function and disease. Each month, the distinguished Editorial Board monitors and selects only the best articles on subjects such as immunology, chronic hepatitis, viral hepatitis, cirrhosis, genetic and metabolic liver diseases and their complications, liver cancer, and drug metabolism. Hepatology is published on behalf of the American Association for the Study of Liver Diseases (AASLD). For more information, please visit http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1527-3350

About Wiley-Blackwell

Wiley-Blackwell is the international scientific, technical, medical, and scholarly publishing business of John Wiley & Sons, with strengths in every major academic and professional field and partnerships with many of the world's leading societies. Wiley-Blackwell publishes nearly 1,500 peer-reviewed journals and 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols. For more information, please visit www.wileyblackwell.com or our new online platform, Wiley Online Library (wileyonlinelibrary.com), one of the world's most extensive multidisciplinary collections of online resources, covering life, health, social and physical sciences, and humanities

Wiley

Related Gastrointestinal Bleeding Articles from Brightsurf:

Review finds almost 20% of COVID-19 patients only show gastrointestinal symptoms
Almost one in five patients with COVID-19 may only show gastrointestinal symptoms, according to a review of academic studies published in the journal Abdominal Radiology.

Gastrointestinal innovation holds potential for treating variety of conditions
Proof-of-concept studies in models of lactose intolerance, diabetes and infectious disease demonstrate potential applications.

Study: Surgical delay associated with increased risk in some gastrointestinal malignancies
Early in the COVID-19 pandemic, widespread cancellations of electively-scheduled or ''non-emergency'' operations were implemented to free up hospital beds and conserve protective equipment for health care workers.

Happiness might protect you from gastrointestinal distress
Serotonin, a chemical known for its role in producing feelings of well-being and happiness in the brain, can reduce the ability of some intestinal pathogens to cause deadly infections, new research by UT Southwestern scientists suggests.

Four of ten adults worldwide have functional gastrointestinal disorders
For every ten adults in the world, four suffer from functional gastrointestinal disorders of varying severity.

Algae shown to improve gastrointestinal health
A green, single-celled organism called Chlamydomonas reinhardtii has served as a model species for topics spanning algae-based biofuels to plant evolution.

Should patients continue blood thinners after experiencing gastrointestinal bleeding?
Anticoagulants and antiplatelet drugs, which are blood thinners such as warfarin and aspirin, are commonly taken to reduce the risk of potentially fatal blood clots, but they carry an increased risk of gastrointestinal bleeding.

Higher salt intake can cause gastrointestinal bloating
A study led by researchers at the Johns Hopkins Bloomberg School of Public Health found that individuals reported more gastrointestinal bloating when they ate a diet high in salt.

Investigators explore temperature-triggered devices for gastrointestinal therapies
Investigators from Brigham and Women's Hospital and MIT are designing devices that can be triggered by the ingestion of a warm liquid to break down into smaller segments that can be excreted.

New therapeutic strategy to prevent gastrointestinal disease
In a study published in Nature Medicine, the researchers report new evidence suggesting that specifically targeting MLCK1 may be effective in both preventing and treating gastrointestinal disease by preserving and restoring barrier function, respectively.

Read More: Gastrointestinal Bleeding News and Gastrointestinal Bleeding Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.