Terlipressin-induced ischaemic skin necrosis. Issue 1 (15th January 2020)

• Record Type: Journal Article
• Authors: Kulkarni, Anand V; Kumar, Pramod; Rao, Nagaraj P; Reddy, Nageshwar
• Is Part Of: BMJ case reports. Volume 13:Issue 1(2020)
• Publication Date: 2020-01-15
• Subjects: alcoholic liver disease -- dermatological -- unwanted effects/adverse reactions -- acute renal failure; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2019-233089
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : Terlipressin is a commonly used drug in hepatology practice for the two most serious complications of cirrhosis, that is, acute oesophageal variceal bleed and hepatorenal syndrome. Acute-on-chronic liver failure (ACLF) is a medical emergency and is frequently associated with acute kidney injury (AKI). Two male patients with alcohol-induced ACLF with high MELD (Model for End-Stage Liver Disease) score presented with AKI. Both were treated with terlipressin infusion. There was no response to terlipressin in these sick patients, and further both patients developed ischaemic skin necrosis and succumbed to multiorgan failure. Continuous infusion of terlipressin is superior to bolus dosing, but we noted that continuous infusion might as well be associated with severe adverse effects in patients with a high MELD score. More extensive prospective studies, including patients with high MELD score, are required to ascertain the safety of terlipressin.