{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T01:53:16Z","timestamp":1775267596954,"version":"3.50.1"},"reference-count":24,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,1,7]]},"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:p>Terlipressin is a commonly used drug in hepatology practice for the two most serious complications of cirrhosis, that is, acute oesophageal variceal bleed and hepatorenal syndrome. Acute-on-chronic liver failure (ACLF) is a medical emergency and is frequently associated with acute kidney injury (AKI). Two male patients with alcohol-induced ACLF with high MELD (Model for End-Stage Liver Disease) score presented with AKI. Both were treated with terlipressin infusion. There was no response to terlipressin in these sick patients, and further both patients developed ischaemic skin necrosis and succumbed to multiorgan failure. Continuous infusion of terlipressin is superior to bolus dosing, but we noted that continuous infusion might as well be associated with severe adverse effects in patients with a high MELD score. More extensive prospective studies, including patients with high MELD score, are required to ascertain the safety of terlipressin.<\/jats:p>","DOI":"10.1136\/bcr-2019-233089","type":"journal-article","created":{"date-parts":[[2020,1,16]],"date-time":"2020-01-16T04:36:44Z","timestamp":1579149404000},"page":"e233089","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Terlipressin-induced ischaemic skin necrosis"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1240-1675","authenticated-orcid":false,"given":"Anand V","family":"Kulkarni","sequence":"first","affiliation":[{"name":"Hepatology and Liver Transplantation, Asian Institute of Gastroenterology, Hyderabad, Telangana, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pramod","family":"Kumar","sequence":"additional","affiliation":[{"name":"Hepatology and Liver Transplantation, Asian Institute of Gastroenterology, Hyderabad, Telangana, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nagaraj P","family":"Rao","sequence":"additional","affiliation":[{"name":"Hepatology and Liver Transplantation, Asian Institute of Gastroenterology, Hyderabad, Telangana, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nageshwar","family":"Reddy","sequence":"additional","affiliation":[{"name":"Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,1,15]]},"reference":[{"key":"2025082712293309000_13.1.e233089.1","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.jhep.2018.03.024","article-title":"EASL clinical practice guidelines for the management of patients with decompensated cirrhosis","volume":"69","year":"2018","journal-title":"J Hepatol"},{"key":"2025082712293309000_13.1.e233089.2","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1007\/s12072-014-9580-2","article-title":"Acute-On-Chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL) 2014","volume":"8","author":"Sarin","year":"2014","journal-title":"Hepatol Int"},{"key":"2025082712293309000_13.1.e233089.3","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.02.042"},{"key":"2025082712293309000_13.1.e233089.4","doi-asserted-by":"crossref","first-page":"5","DOI":"10.12659\/AJCR.913150","article-title":"Terlipressin-Induced peripheral cyanosis in a patient with liver cirrhosis and hepatorenal syndrome","volume":"20","author":"Chiang","year":"2019","journal-title":"Am J Case Rep"},{"key":"2025082712293309000_13.1.e233089.5","doi-asserted-by":"crossref","first-page":"380","DOI":"10.17235\/reed.2017.4466\/2016","article-title":"Cutaneous necrosis secondary to terlipressin therapy. 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