TITLE

WORSENING OF CEREBRAL HYPERAEMIA IN ACUTE LIVER FAILURE (ALF) WITH TERLIPRESSIN

AUTHOR(S)
Shawcross, D.L.; Mookerjee, R.P.; Hayes, P.C.; Lee, A.; Williams, R.; Jalan, R.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA1
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: The role of terlipressin in ALF patients is not clear. Terlipressin acts through the V1 and V2 receptors. V1 receptors, distributed in the systemic circulation, mediate vasoconstriction. V2 receptors, distributed in the cerebral vasculature, in contrast mediate cerebral vasodilatation through a nitric oxide dependent mechanism. It is therefore possible that terlipressin may accentuate cerebral hyperaemia and worsen intracranial pressure (ICP) in ALF. This study evaluated the haemodynamic effect of a small dose of terlipressin in six patients [median age 27 (22-46), four female] with ALF (paracetamol four, acute fatty liver of pregnancy one, non A/non B viral one) and grade IV encephalopathy. Method: ICP was continuously monitored in five/six patients using a subdural fibreoptic system. Cardiovascular haemodynamics were monitored with pulmonary artery, right atrial, and arterial catheters. Jugular venous oxygen saturation (JVOS) was monitored using a reverse jugular catheter and cerebral blood flow (CBF) was measured using a modified Kety-Schmidt technique, prior to and 1 hour after administration of 0.01 mg/kg of terlipressin intravenously as a single bolus. Results: There was no significant rise in mean arterial pressure (MAP). ICP increased in all patients [median 15 (range 13-18) to 20 (range 16-23) mmHg; p < 0.02] after 1 hour and returned to baseline values after 3 hours. CBF increased significantly at 1 hour [median 69 (range 48-79) to 81 (range 62-97) mi/100 g/min; p < 0.02. JVOS increased at 1 hour [median 75% (range 67-89) to 87% (range 75-94)]. Conclusions: Administration of even a sub-therapeutic dose of terlipressin increases CBF and consequently ICP, without causing significant change to systemic haemodynamics. Terlipressin may therefore have deleterious consequences through worsening of cerebral hyperaemia and ICP. These data suggest extreme caution and close monitoring if this drug is used in patients with ALF.
ACCESSION #
9747248

 

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