# Severe Lactic Acidosis With Multi-organ Dysfunction Secondary to Terlipressin-Induced Widespread Vasospasm in a Patient With Liver Cirrhosis and Oesophageal Variceal Bleeding: A Case Report

## TL;DR

A patient with liver cirrhosis developed severe lactic acidosis and organ failure after terlipressin treatment, likely due to widespread vasospasm.

## Contribution

Reports a rare but severe complication of terlipressin use in liver cirrhosis patients.

## Key findings

- Patient developed severe lactic acidosis (20 mmol/L) and acidemia (pH 6.97) after terlipressin.
- Clinical improvement followed terlipressin discontinuation and octreotide initiation.
- Alternative causes of lactic acidosis were ruled out.

## Abstract

Terlipressin is widely used for acute variceal bleeding and hepato-renal syndrome, but rare complications such as severe lactic acidosis with multi-organ dysfunction due to systemic vasospasm can occur. We report a 58-year-old male with type 2 diabetes and alcoholic liver cirrhosis who developed a lactate level of 20 mmol/L and a pH of 6.97. He became systemically unwell hours after terlipressin initiation. Further investigations excluded alternative causes of lactic acidosis. Clinical improvement occurred, followed by discontinuation of terlipressin and initiation of octreotide, highlighting the need for vigilance during therapy.