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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Issue 11
Nov.  2016
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Article Contents

Mechanisms of hyponatremia in patients with decompensated liver cirrhosis treated with terlipressin and related treatment principles

DOI: 10.3969/j.issn.1001-5256.2016.11.043
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  • Published Date: 2016-11-20
  • Esophagogastric variceal bleeding and hepatorenal syndrome are common complications in patients with decompensated liver cirrhosis and portal hypertension. Terlipressin can lead to the constriction of visceral vessels,reduce portal venous pressure,and increase renal perfusion and is the first- line drug. In recent years,it has been reported that some patients experienced hyponatremia during the treatment with terlipressin. Since patients with liver cirrhosis tend to develop hyponatremia,the application of terlipressin may have an adverse effect on the management of serum sodium level in such patients. This article summarizes the incidence rate of hyponatremia during terlipressin treatment and related risk factors and introduces the pathogenesis of hyponatremia during terlipressin treatment in patients with decompensated liver cirrhosis and the treatment principles for hyponatremia. If the occurrence of hyponatremia can be controlled,terlipressin may be an effective drug for the treatment of portal hypertension.

     

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  • [1]MOLLER S,HANSEN EF,BECKER U,et al.Central and systemic haemodynamic effects of terlipressin in portal hypertensive patients[J].Liver,2000,20(1):51-59.
    [2]ARROYO V,GUEVARA M,GINES P.Hepatorenal syndrome in cirrhosis:pathogenesis and treatment[J].Gastroenterology,2002,122(6):1658-1676.
    [3]de FRANCHIS R,BavenoⅥFaculty.Expanding consensus in portal hypertension:Report of the BavenoⅥConsensus Workshop:stratifying risk and individualizing care for portal hypertension[J].J Hepatol,2015,63(3):743-752.
    [4]TRIPATHI D,STANLEY AJ,HAYES PC,et al.UK guidelines on the management of variceal haemorrhage in cirrhotic patients[J].Gut,2015,64(11):1680-1704.
    [5]Chinese Society of Hepatology,Chinese Medical Association;Chinese Society of Gastroenterology,Chinese Medical Association;Chinese Society of Endoscopy,Chinese Medical Association.Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J].J Clin Hepatol,2016,32(2):203-219.(in Chinese)中华医学会肝病学分会,中华医学会消化病学分会,中华医学会内镜学分会,等.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].临床肝胆病杂志,2016,32(2):203-219.
    [6]ANGELI P,GINS P,WONG F,et al.Diagnosis and management of acute kidney injury in patients with cirrhosis:revised consensus recommendations of the International Club of Ascites[J].Gut,2015,64(4):531-537.
    [7]RUNYON BA,AASLD.Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis2012[J].Hepatology,2013,57(4):1651-1653.
    [8]DING XH,GU JY.Clinical efficacy of terlipressin in treatment of typeⅡhepatorenal syndrome[J].J Clin Hepatol,2015,31(5):745-748.(in Chinese)丁晓红,顾建英.特利加压素治疗Ⅱ型肝肾综合征的临床疗效观察[J].临床肝胆病杂志,2015,31(5):745-748.
    [9]JOHN S,THULUVATH PJ.Hyponatremia in cirrhosis:pathophysiology and management[J].World J Gastroenterol,2015,21(11):3197-3205.
    [10]GINS P,BERL T,BERNARDI M,et al.Hyponatraemia in cirrhosis:from pathogenesis to treatment[J].Hepatology,1998,28(3):851-864.
    [11]JALAN R,HAYES PC.Sodium handling in patients with well compensated cirrhosis is dependent on the severity of liver disease and portal pressure[J].Gut,2000,46(4):527-533.
    [12]GEILSWIJK M,THOMSEN KL,PEDERSEN EB,et al.Urinary aquaporin-2 excretion before and after transjugular intrahepatic portosystemic shunt insertion for refractory ascites[J].Scand J Gastroenterol,2015,50(4):454-461.
    [13]NAKANISHI H,KUROSAKI M,HOSOKAWA T,et al.Urinary excretion of the water channel aquaporin 2 correlated with the pharmacological effect of tolvaptan in cirrhotic patients with ascites[J].J Gastroenterol,2016,51(6):620-627.
    [14]CHEN C,CHEN RP,LIN HH,et al.Tolvaptan regulates aquaporin-2 and fecal water in cirrhotic rats with ascites[J].World J Gastroenterol,2016,22(12):3363-3371.
    [15]HUANG YY,SUN JY,WANG JY,et al.Terlipressin resolves ascites of cirrhotic rats through downregulation of aquaporin 2[J].J Int Med Res,2012,40(5):1735-1744.
    [16]ESTEVA-FONT C,BACCARO ME,FERNNDEZ-LLAMA P,et al.Aquaporin-1 and aquaporin-2 urinary excretion in cirrhosis:relationship with ascites and hepatorenal syndrome[J].Hepatology,2006,44(6):1555-1563.
    [17]LEE WC,LIN HC,YANG YY,et al.Hemodynamic effects of a combination of prazosin and terlipressin in patients with viral cirrhosis[J].Am J Gastroenterol,2001,96(4):1210-1216.
    [18]TRIANTOA CK,SAMONAKIS D,THALHEIMER U,et al.Terlipressin therapy for renal failure in cirrhosis[J].Eur J Gastroenterol Hepatol,2010,22(4):481-486.
    [19]FERNNDEZ-VARO G,ORD,CABLE E,et al.Evasopressin 1αreceptor partial agonist increases sodium excretion and reduces portal hypertension and ascites in cirrhotic rats[J].Hepatology,2016,63(1):207-216.
    [20]FENTON RA,KNEPPER MA.Mouse models and the urinary concentrating mechanism in the new millennium[J].Physiol Rev,2007,87(4):1083-1112.
    [21]FEU F,RUIZ del ARBOL L,BANARES R,et al.Doubleblind randomized controlled trial comparing terlipressin and somatostatin for acute variceal hemorrhage.Variceal Bleeding Study Group[J].Gastroenterology,1996,111(5):1291-1299.
    [22]ESCORSELL A,ARBOL LRD,PLANAS R,et al.Multicenter randomized controlled trial of terlipressin versus sclerotherapy in the treatment of acute variceal bleeding:the TEST study[J].Hepatology,2000,32(3):471-476.
    [23]SOLA E,LENS S,GUEVARA M,et al.Hyponatremia in patients treated with terlipressin for severe gastrointestinal bleeding due to portal hypertension[J].Hepatology,2010,52(5):1783-1790.
    [24]YIM SY,SEO YS,JUNG CH,et al.Risk factors for developing hyponatremia during terlipressin treatment:a retrospective analyses in variceal bleeding[J].J Clin Gastroenterol,2015,49(7):607-612.
    [25]KANG YJ,BAE EJ,HWANG K,et al.Initial serum sodium concentration determines the decrease in sodium level after terlipressin administration in patients with liver cirrhosis[J].Springerplus,2013,2:519.
    [26]ZAKI SA.Terlipressin-induced hyponatremic seizure in a child[J].Indian J Pharmacol,2013,45(4):403-404.
    [27]BRUHA R,MARECEK Z,PROCHAZKA V,et al.Doubleblind randomized multicenter study comparing the efficacy and safety of 10-day to 5-day terlipressin treatment of bleeding esophageal varices[J].Hepatogastroenterology,2009,56(90):390-394.
    [28]CHANG TT,LEE FY,TSAI YT,et al.A randomized control ed study of low-dose and high-dose terlipressin in the control of acute oesophageal variceal haemorrhage[J].J Gastroenterol Hepatol,1991,6(5):481-484.
    [29]KRAG A,BENDTSEN F,PEDERSEN EB.Effects of terlipressin on the aquaretic system:evidence of antidiuretic effects[J].Am J Physiol Renal Physiol,2008,295(5):1295-1300.
    [30]NIELSEN S,FROKIAR J,MARPLES D,et al.Aquaporins in the kidney:from molecules to medicine[J].Physiol Rev,2002,82(1):205-244.
    [31]KALAMBOKIS GN,PAPPAS K,BALTAYIANNIS G.Effects of terlipressin on water excretion after oral water load test in nonazotemic cirrhotic patients with ascites without hyponatremia[J].Scand J Gastroenterol,2010,45(12):1509-1515.
    [32]BANKIR L.Antidiuretic action of vasopressin:quantitative aspects and interaction between V1a and V2 receptor-mediated effects[J].Cardiovasc Res,2001,51(3):372-390.
    [33]URIZ J,GINES P,CARDENAS A,et al.Terlipressin plus albumin infusion:an effective and safe therapy of hepatorenal syndrome[J].J Hepatol,2000,33(1):43-48.
    [34]ORTEGA R,GINES P,URIZ J,et al.Terlipressin therapy with and without albumin for patients with hepatorenal syndrome:results of a prospective,nonrandomized study[see comment][J].Hepatology,2002,36(4 Pt 1):941-948.
    [35]BOYER TD,SANYAL AJ,GARCIA-TSAO G,et al.Terlipressin Study Group.Predictors of response to terlipressin plus albumin in hepatorenal syndrome(HRS)type 1:relationship of serum creatinine to hemodynamics[J].J Hepatol,2011,55(2):315-321.
    [36]SHARMA P,SINGH S,SARIN SK.Hyponatremia in patients with acute variceal bleeding treated with terlipressin[J].Hepatology,2011,53(2):714.
    [37]DUNWOODIE E,JOWETT S.Terlipressin causing a hyponatraemic seizure[J].Scand J Gastroenterol,2007,42(5):665.
    [38]SIMA M,POKORNY M,PAD OUR F.Terlipressin induced severe hyponatremia[J].Prague Med Rep,2016,117(1):68-72.
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