Terlipressin-induced ischaemic skin necrosis.
Anand V KulkarniPramod KumarNagaraj P RaoNageshwar ReddyPublished in: BMJ case reports (2020)
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.
Keyphrases
- liver failure
- acute kidney injury
- end stage renal disease
- drug induced
- newly diagnosed
- ejection fraction
- healthcare
- hepatitis b virus
- chronic kidney disease
- peritoneal dialysis
- emergency department
- cardiac surgery
- prognostic factors
- high glucose
- case report
- primary care
- patient reported outcomes
- oxidative stress
- risk factors
- endothelial cells
- mechanical ventilation