Risk Factors for Developing Hyponatremia during Terlipressin Treatment

A Retrospective Analyses in Variceal Bleeding

Sun Young Yim, Yeon Seok Seo, Chang Ho Jung, Tae Hyung Kim, Eun-Sun Kim, Bora Keum, Ji Hoon Kim, Hyonggin An, Hyung Joon Yim, Jong Eun Yeon, Yoon Tae Jeen, Hong Sik Lee, Hoon-Jai Chun, Kwan Soo Byun, Soon-Ho Um, Chang Duck Kim, Ho Sang Ryu

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Abstract

Goals: The aim of this study was to evaluate the risk factors and clinical significance of terlipressin-induced hyponatremia. Background: Patients receiving terlipressin treatment frequently develop hyponatremia. However, its clinical significance and risk factors are not fully elucidated. Study: Records of patients treated with terlipressin for variceal bleeding were analyzed. Hyponatremia was defined as a decrease in serum sodium (Na) level of >5 mEq/L from the baseline level; severe hyponatremia as a decrease in serum Na level of >10 mEq/L from the baseline level; and rapid severe hyponatremia as a decrease in serum Na level of >10 mEq/L within 3 days of treatment. Results: The study involved 151 patients (mean age, 55.1±11.8 y) with male predominance (80.8%). Baseline serum Na and creatinine levels were 137.2±6.1 mEq/L and 0.9±0.4 mg/dL, respectively. Patients were treated with terlipressin for 4.5±1.9 days. Changes in serum Na levels from baseline were 0.4±4.1, -1.1±4.8, -4.0±7.0, -6.5±9.1, and -6.1±11.2 mEq/L, whereas the frequencies of hyponatremia and severe hyponatremia were 13.6%, 30.4%, 50.8%, 63.5%, and 66.9% and 0%, 8.8%, 23.3%, 33.0%, and 38.8% on days 1, 2, 3, 4, and 5 of treatment, respectively. Younger age, lower Child-Pugh score, higher serum Na level, and longer duration of terlipressin treatment were independent risk factors. Rapid severe hyponatremia developed in 29 patients (19.2%); lower body mass index was an additional risk factor in this group. Mortality was not associated with hyponatremia. Conclusions: Terlipressin-induced hyponatremia occurred frequently, especially in young patients with good liver function and higher Na level. Caution is required when administering terlipressin to patients with low body mass index.

Original languageEnglish
Pages (from-to)607-612
Number of pages6
JournalJournal of Clinical Gastroenterology
Volume49
Issue number7
DOIs
Publication statusPublished - 2015 Jul 23

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Hyponatremia
Hemorrhage
Serum
Therapeutics
Body Mass Index
terlipressin
Creatinine
Sodium
Mortality

Keywords

  • body mass index
  • hyponatremia
  • terlipressin
  • variceal bleeding

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{b22995aeb72a4c5bb0c92b44cffc7251,
title = "Risk Factors for Developing Hyponatremia during Terlipressin Treatment: A Retrospective Analyses in Variceal Bleeding",
abstract = "Goals: The aim of this study was to evaluate the risk factors and clinical significance of terlipressin-induced hyponatremia. Background: Patients receiving terlipressin treatment frequently develop hyponatremia. However, its clinical significance and risk factors are not fully elucidated. Study: Records of patients treated with terlipressin for variceal bleeding were analyzed. Hyponatremia was defined as a decrease in serum sodium (Na) level of >5 mEq/L from the baseline level; severe hyponatremia as a decrease in serum Na level of >10 mEq/L from the baseline level; and rapid severe hyponatremia as a decrease in serum Na level of >10 mEq/L within 3 days of treatment. Results: The study involved 151 patients (mean age, 55.1±11.8 y) with male predominance (80.8{\%}). Baseline serum Na and creatinine levels were 137.2±6.1 mEq/L and 0.9±0.4 mg/dL, respectively. Patients were treated with terlipressin for 4.5±1.9 days. Changes in serum Na levels from baseline were 0.4±4.1, -1.1±4.8, -4.0±7.0, -6.5±9.1, and -6.1±11.2 mEq/L, whereas the frequencies of hyponatremia and severe hyponatremia were 13.6{\%}, 30.4{\%}, 50.8{\%}, 63.5{\%}, and 66.9{\%} and 0{\%}, 8.8{\%}, 23.3{\%}, 33.0{\%}, and 38.8{\%} on days 1, 2, 3, 4, and 5 of treatment, respectively. Younger age, lower Child-Pugh score, higher serum Na level, and longer duration of terlipressin treatment were independent risk factors. Rapid severe hyponatremia developed in 29 patients (19.2{\%}); lower body mass index was an additional risk factor in this group. Mortality was not associated with hyponatremia. Conclusions: Terlipressin-induced hyponatremia occurred frequently, especially in young patients with good liver function and higher Na level. Caution is required when administering terlipressin to patients with low body mass index.",
keywords = "body mass index, hyponatremia, terlipressin, variceal bleeding",
author = "Yim, {Sun Young} and Seo, {Yeon Seok} and Jung, {Chang Ho} and Kim, {Tae Hyung} and Eun-Sun Kim and Bora Keum and Kim, {Ji Hoon} and Hyonggin An and Yim, {Hyung Joon} and Yeon, {Jong Eun} and Jeen, {Yoon Tae} and Lee, {Hong Sik} and Hoon-Jai Chun and Byun, {Kwan Soo} and Soon-Ho Um and Kim, {Chang Duck} and Ryu, {Ho Sang}",
year = "2015",
month = "7",
day = "23",
doi = "10.1097/MCG.0000000000000217",
language = "English",
volume = "49",
pages = "607--612",
journal = "Journal of Clinical Gastroenterology",
issn = "0192-0790",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

TY - JOUR

T1 - Risk Factors for Developing Hyponatremia during Terlipressin Treatment

T2 - A Retrospective Analyses in Variceal Bleeding

AU - Yim, Sun Young

AU - Seo, Yeon Seok

AU - Jung, Chang Ho

AU - Kim, Tae Hyung

AU - Kim, Eun-Sun

AU - Keum, Bora

AU - Kim, Ji Hoon

AU - An, Hyonggin

AU - Yim, Hyung Joon

AU - Yeon, Jong Eun

AU - Jeen, Yoon Tae

AU - Lee, Hong Sik

AU - Chun, Hoon-Jai

AU - Byun, Kwan Soo

AU - Um, Soon-Ho

AU - Kim, Chang Duck

AU - Ryu, Ho Sang

PY - 2015/7/23

Y1 - 2015/7/23

N2 - Goals: The aim of this study was to evaluate the risk factors and clinical significance of terlipressin-induced hyponatremia. Background: Patients receiving terlipressin treatment frequently develop hyponatremia. However, its clinical significance and risk factors are not fully elucidated. Study: Records of patients treated with terlipressin for variceal bleeding were analyzed. Hyponatremia was defined as a decrease in serum sodium (Na) level of >5 mEq/L from the baseline level; severe hyponatremia as a decrease in serum Na level of >10 mEq/L from the baseline level; and rapid severe hyponatremia as a decrease in serum Na level of >10 mEq/L within 3 days of treatment. Results: The study involved 151 patients (mean age, 55.1±11.8 y) with male predominance (80.8%). Baseline serum Na and creatinine levels were 137.2±6.1 mEq/L and 0.9±0.4 mg/dL, respectively. Patients were treated with terlipressin for 4.5±1.9 days. Changes in serum Na levels from baseline were 0.4±4.1, -1.1±4.8, -4.0±7.0, -6.5±9.1, and -6.1±11.2 mEq/L, whereas the frequencies of hyponatremia and severe hyponatremia were 13.6%, 30.4%, 50.8%, 63.5%, and 66.9% and 0%, 8.8%, 23.3%, 33.0%, and 38.8% on days 1, 2, 3, 4, and 5 of treatment, respectively. Younger age, lower Child-Pugh score, higher serum Na level, and longer duration of terlipressin treatment were independent risk factors. Rapid severe hyponatremia developed in 29 patients (19.2%); lower body mass index was an additional risk factor in this group. Mortality was not associated with hyponatremia. Conclusions: Terlipressin-induced hyponatremia occurred frequently, especially in young patients with good liver function and higher Na level. Caution is required when administering terlipressin to patients with low body mass index.

AB - Goals: The aim of this study was to evaluate the risk factors and clinical significance of terlipressin-induced hyponatremia. Background: Patients receiving terlipressin treatment frequently develop hyponatremia. However, its clinical significance and risk factors are not fully elucidated. Study: Records of patients treated with terlipressin for variceal bleeding were analyzed. Hyponatremia was defined as a decrease in serum sodium (Na) level of >5 mEq/L from the baseline level; severe hyponatremia as a decrease in serum Na level of >10 mEq/L from the baseline level; and rapid severe hyponatremia as a decrease in serum Na level of >10 mEq/L within 3 days of treatment. Results: The study involved 151 patients (mean age, 55.1±11.8 y) with male predominance (80.8%). Baseline serum Na and creatinine levels were 137.2±6.1 mEq/L and 0.9±0.4 mg/dL, respectively. Patients were treated with terlipressin for 4.5±1.9 days. Changes in serum Na levels from baseline were 0.4±4.1, -1.1±4.8, -4.0±7.0, -6.5±9.1, and -6.1±11.2 mEq/L, whereas the frequencies of hyponatremia and severe hyponatremia were 13.6%, 30.4%, 50.8%, 63.5%, and 66.9% and 0%, 8.8%, 23.3%, 33.0%, and 38.8% on days 1, 2, 3, 4, and 5 of treatment, respectively. Younger age, lower Child-Pugh score, higher serum Na level, and longer duration of terlipressin treatment were independent risk factors. Rapid severe hyponatremia developed in 29 patients (19.2%); lower body mass index was an additional risk factor in this group. Mortality was not associated with hyponatremia. Conclusions: Terlipressin-induced hyponatremia occurred frequently, especially in young patients with good liver function and higher Na level. Caution is required when administering terlipressin to patients with low body mass index.

KW - body mass index

KW - hyponatremia

KW - terlipressin

KW - variceal bleeding

UR - http://www.scopus.com/inward/record.url?scp=84937735484&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84937735484&partnerID=8YFLogxK

U2 - 10.1097/MCG.0000000000000217

DO - 10.1097/MCG.0000000000000217

M3 - Article

VL - 49

SP - 607

EP - 612

JO - Journal of Clinical Gastroenterology

JF - Journal of Clinical Gastroenterology

SN - 0192-0790

IS - 7

ER -