{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:06:18Z","timestamp":1760058378072,"version":"build-2065373602"},"reference-count":20,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicines"],"abstract":"<jats:p>Background: Hyponatraemia is a rare but potentially life-threatening complication of terlipressin therapy. Case history: In the current case, a 39-year-old female with decompensated liver cirrhosis (Child-Pugh C) and acute variceal bleeding experienced a precipitous decline in serum sodium\u2014from 136 mmol\/L to 115 mmol\/L\u2014within 48 h of initiating terlipressin therapy. This was accompanied by marked fluid retention, reduced urine output, and symptoms of confusion and agitation. Laboratory tests confirmed dilutional hyponatraemia, characterized by urinary sodium &lt;20 mmol\/L and urine osmolality &lt;100 mOsm\/kg, indicating excessive free water reabsorption. Outcomes: The prompt discontinuation of terlipressin, fluid restriction and the cautious administration of hypertonic sodium chloride solution (2.7% NaCl) achieved a gradual normalization of sodium levels and resolution of symptoms. Fluid balance monitoring revealed a marked diuretic response following terlipressin cessation. This case aligns with existing reports, emphasizing the dual vasopressin receptor activity of terlipressin and its capacity to induce hyponatraemia, particularly in cirrhotic patients with preserved renal function and higher baseline sodium levels. Conclusions: This case and a literature review underscored the critical need for early fluid balance monitoring to detect retention. This case highlights the importance of individualized risk assessment, multidisciplinary management, and vigilant sodium correction to avoid complications. Practical recommendations are outlined to aid clinicians in the recognition and management of terlipressin-induced hyponatraemia.<\/jats:p>","DOI":"10.3390\/medicines12020007","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T06:45:51Z","timestamp":1743144351000},"page":"7","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hyponatraemia Induced by Terlipressin in Patients Diagnosed with Decompensated Liver Cirrhosis and Acute Variceal Bleeding"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3678-7103","authenticated-orcid":false,"given":"Mahmoud","family":"Elshehawy","sequence":"first","affiliation":[{"name":"West Midlands Deanery, Birmingham B2 4HQ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richel Merin","family":"Panicker","sequence":"additional","affiliation":[{"name":"General Internal Medicine, Royal Shrewsbury Hospital, Shrewsbury SY3 8XQ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8635-8584","authenticated-orcid":false,"given":"Alaa Amr","family":"Abdelgawad","sequence":"additional","affiliation":[{"name":"Mansoura University Hospitals, Mansoura 35516, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8918-2119","authenticated-orcid":false,"given":"Patrick Anthony","family":"Ball","sequence":"additional","affiliation":[{"name":"School of Medical and Dental Sciences, Charles Sturt University, Bathurst, NSW 2795, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9752-537X","authenticated-orcid":false,"given":"Hana","family":"Morrissey","sequence":"additional","affiliation":[{"name":"Independent Researcher, 6036 Perth, Australia"},{"name":"School of Pharmacy, University of Ruhuna, Matara 81000, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1111\/liv.13252","article-title":"A randomized trial comparing terlipressin and noradrenaline in patients with cirrhosis and septic shock","volume":"37","author":"Choudhury","year":"2017","journal-title":"Liver Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"68","DOI":"10.14712\/23362936.2016.7","article-title":"Terlipressin Induced Severe Hyponatremia","volume":"117","year":"2016","journal-title":"Prague Med. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1002\/hep.24065","article-title":"Hyponatremia in patients treated with terlipressin: Mechanisms and implications for clinical practice","volume":"53","author":"Krag","year":"2011","journal-title":"Hepatology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e0526","DOI":"10.1097\/HC9.0000000000000526","article-title":"Incidence and type of adverse events in patients with cirrhosis receiving terlipressin: A systematic review and meta-analysis","volume":"8","author":"Shang","year":"2024","journal-title":"Hepatol. Commun."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.kjms.2013.08.003","article-title":"Terlipressin-induced hyponatremic encephalopathy in a noncirrhotic patient","volume":"29","author":"Wang","year":"2013","journal-title":"Kaohsiung J. Med. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1097\/MCG.0000000000000217","article-title":"Risk Factors for Developing Hyponatremia During Terlipressin Treatment: A Retrospective Analyses in Variceal Bleeding","volume":"49","author":"Yim","year":"2015","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1080\/14740338.2020.1734558","article-title":"Development of hyponatremia after terlipressin in cirrhotic patients with acute gastrointestinal bleeding: A retrospective multicenter observational study","volume":"19","author":"Xu","year":"2020","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1111\/jcpt.13031","article-title":"Severe hyponatraemia with neurological manifestations in patients treated with terlipressin: Two case reports","volume":"44","author":"Meng","year":"2019","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1111\/jcpt.12335","article-title":"Hyponatraemia induced by terlipressin: A case report and literature review","volume":"40","author":"Huang","year":"2015","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1186\/2193-1801-2-519","article-title":"Initial serum sodium concentration determines the decrease in sodium level after terlipressin administration in patients with liver cirrhosis","volume":"2","author":"Kang","year":"2013","journal-title":"Springerplus"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1002\/jgh3.12254","article-title":"A retrospective analysis of hyponatremia during terlipressin treatment in patients with esophageal or gastric variceal bleeding due to portal hypertension","volume":"4","author":"Han","year":"2020","journal-title":"JGH Open"},{"key":"ref_12","unstructured":"World Health Organisation (2014). The Use of The Who-Umc System for Standardised Case Causality Assessment Uppsala Sweden, WHO."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1002\/hep.31884","article-title":"Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases","volume":"74","author":"Biggins","year":"2021","journal-title":"Hepatology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1210\/endrev\/bnad010","article-title":"Syndrome of Inappropriate Antidiuresis: From Pathophysiology to Management","volume":"44","author":"Warren","year":"2023","journal-title":"Endocr. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"7610374","DOI":"10.1155\/2017\/7610374","article-title":"Baseline Renal Function Predicts Hyponatremia in Liver Cirrhosis Patients Treated with Terlipressin for Variceal Bleeding","volume":"2017","author":"Kim","year":"2017","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1002\/hep.23893","article-title":"Hyponatremia in patients treated with terlipressin for severe gastrointestinal bleeding due to portal hypertension","volume":"52","author":"Lens","year":"2010","journal-title":"Hepatology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1111\/jcpt.13057","article-title":"Clinical characteristics and risk factors of severe hyponatremia in cirrhotic patients treated with terlipressin","volume":"45","author":"Pan","year":"2020","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3197","DOI":"10.3748\/wjg.v21.i11.3197","article-title":"Hyponatremia in cirrhosis: Pathophysiology and management","volume":"21","author":"John","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_19","first-page":"e64576","article-title":"Severe Hyponatremia Associated with Terlipressin Use in Esophageal Variceal Bleeding","volume":"16","author":"AlKindi","year":"2024","journal-title":"Cureus"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2888","DOI":"10.1111\/liv.14703","article-title":"Terlipressin has stood the test of time: Clinical overview in 2020 and future perspectives","volume":"40","author":"Kulkarni","year":"2020","journal-title":"Liver Int."}],"container-title":["Medicines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2305-6320\/12\/2\/7\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:03:58Z","timestamp":1760029438000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2305-6320\/12\/2\/7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,28]]},"references-count":20,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["medicines12020007"],"URL":"https:\/\/doi.org\/10.3390\/medicines12020007","relation":{},"ISSN":["2305-6320"],"issn-type":[{"type":"electronic","value":"2305-6320"}],"subject":[],"published":{"date-parts":[[2025,3,28]]}}}