Impact of terlipressin on hepatosplanchnic perfusion: 'only the dose makes a thing not a poison' (paracelsus).

摘要

To the Editor:-"With great interest, we read the comprehensive and well-written review article of Drs. Treschan and Peters providing a thorough overview of the physiology and therapeutic indications of arginine vasopressin and its synthetic analogs. Nevertheless, we believe that the impact of the long-acting vasopressin analog terlipressin on hepatosplanchnic perfusion in the treatment of sepsis-related arterial hypotension has not been discussed appropriately. The authors conclude that "terlipressin is a potent intestinal vasoconstrictor, and evidence suggests decreased intestinal perfusion with terlipressin infusion." First, we wish to rectify that the cited study of Westphal et al. investigated the effects of arginine vasopressin on gut mucosal microcirculation in septic rats, and not of terlipressin (as wrongly cited by Drs. Treschan and Peters1). Second, the effects of terlipressin on splanchnic perfusion are dependent on two important aspects, which the authors of the current review article did not refer to: (1) the role of aggressive fluid resuscitation and (2) the dose itself. In this context, Asfar et al.