Terlipressin and hyponatraemia: The cause or the treatment?

摘要

I read with interest the paper by Prakoso et ah on ter-lipressin in the treatment of hyponatremia in patients with advanced cirrhosis. Hyponatraemia is a clinical problem with few treatment options. The mechanism of hyponatraemia in cirrhosis is not fully understood, but the pathophysiology involves non-osmotic releases of arginine-vasopressin (AVP). Thus, central hypovolemia and decreased blood pressure with stimulation of arterial and cardiopulmonary baroreceptors are important. Any intervention that improves effective arterial blood volume can potentially improve hyponatraemia in cirrhosis. On the other hand it is noteworthy that treatment with vasopressin-2 receptor antagonists (vaptans) has not been very successful in cirrhosis, suggesting that the pathophysiology is more complex.In the retrospective study by Prakoso et ah, terlipressin (maximum dose 1 mg/4 h) was used in combination with albumin (40 g/day) at median 7 days, and the changes represent a combination of small doses of terlipressin and medium doses of albumin.