Effects of a single dose of terlipressin on transcutaneous oxygen pressures

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.