Effects of a single dose of terlipressin on transcutaneous oxygen pressures

Abstract

Objective. Terlipressin (TP) is a potent vasoconstrictor, which is widely used in the treatment of bleeding esophageal varices and the hepatorenal syndrome. Side effects to TP are often related to skin hypoxaemia. The aim of the study was to investigate the transcutaneous oxygen pressures (TcPO₂ mmHg) after administration of 2 mg of TP. Patients and methods. Nineteen patients with cirrhosis and ascites were included. TcPO₂ mmHg were measured continuously measured at the chest, abdominal wall and at the lower extremity at baseline and after 2 mg TP in 15 patients and placebo in 4 patients. Results. The mean whole body TcPO₂ decreased after TP by 34% (p < 0.005). The decrease was even more pronounced in the lower extremity: above knee -33% (50 vs. 33 mmHg, p = 0.01) and below knee –52% (52 vs. 26 mmHg, p = 0.001). Levels below 30 mmHg, were found in 60% of the patients after TP compared to 0% in the placebo group, p = 0.005. There were no significant changes in TcPO₂ after placebo. The baseline leg TcPO₂ correlated inversely with the MELD score (r = –0.64 and p < 0.003) and the increase in MAP after TP correlated inversely with TcPO₂ at the thorax (r = –0.60, p = 0.009). Conclusions. Sixty percent of patients with decompensated cirrhosis develop hypoxaemia in the lower limb after one dose of TP.

Key Words::

• Ascites
• cirrhosis
• hepatorenal syndrome
• peripheral ischaemia
• terlipressin

Acknowledgements

This study was supported by grants from the Lundbeck Foundation, Hvidovre Hospital Foundation for Liver Disease. Aleksander Krag received a grant from the University of Copenhagen.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.