| Summary: | Background and Aim To explore the risk factors of hyponatremia caused by terlipressin. Methods Forty‐four patients with acute variceal bleeding treated with terlipressin from December 2016 to December 2018 were analyzed. Results During the treatment, serum sodium levels decreased from 137.78 to 126.59 mmol/L (P < 0.05), with an average decrease of 11.19 mmol/L. The serum sodium level decreased by less than 5 mmol/L in 12 patients (27.27%), by 5–10 mmol/L in 13 patients (27.27%), and by more than 10 mmol/L in 19 patients (43.18%). The difference in baseline serum sodium levels was statistically significant (P < 0.05), and the differences in baseline total bilirubin levels, Child‐Pugh scores, and model for end‐stage liver disease scores were also significant. Logistic regression analysis suggested that the initial sodium level was an independent risk factor for the decrease in the serum sodium concentration caused by terlipressin. Conclusion The incidence of hyponatremia is not low during treatment with terlipressin; a higher baseline serum sodium level is a risk factor for hyponatremia during treatment with terlipressin, and the mechanism may be related to endogenous vasopressin preconditioning.
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