[Severe hyponatraemia to terlipressin treatment]

Terlipressin is a vasopressin analogue. The clinical effect is attributable to affinity to vasopressin-1a receptors. However, it also has affinity to renal vasopressin-2 receptors, which can lead to water retention and dilutional hyponatraemia. We report a case of severe hyponatraemia secondary to terlipressin treatment. A 60-year-old woman with bleeding oesophageal varices was treated with terlipressin 2 mg every fourth hour. After 24 hours of treatment she was somnolent, and the sodium concentration had dropped from 127 mmol/l to 107 mmol/l. Hyponatraemia is an important adverse event in terlipressin treatment, and serum sodium should be monitored closely.