pituitrin and Chemical-and-Drug-Induced-Liver-Injury

Vasopressin analogues are increasingly used for haemodynamic support of catecholamine-refractory, hyperdynamic septic shock. Arginine vasopressin (AVP) and terlipressin (TP) effectively increase mean arterial pressure and reduce catecholamine requirements in this condition. However, the use of either of the drugs may be linked to relevant haemodynamic side effects, including reductions in cardiac output, oxygen delivery and mixed-venous oxygen saturation. These alterations may result in impaired tissue perfusion and foster the genesis of ischemic tissue injury. In addition, decreases in platelet count and increases in aminotransferases activity and bilirubin concentration have been reported with the use of V1 agonists. However, it remains unclear whether these changes are of clinical relevance. This review article summarizes the previous data on adverse effects related to the therapy with vasopressin analogues and discusses potential options to prevent such adverse events. In summary, continuous TP infusion appears to be superior to bolus infusion. Maximum doses of 0.03 (-0.067) U min(-1) of AVP or 2 microg kg(-1) h(-1) of TP, respectively, should not be exceeded. Aggressive fluid therapy may prevent adverse haemodynamic effects linked to infusion of either AVP or TP. Finally, platelet count, surrogate variables of hepatic dysfunction, electrolytes and osmolality should be strictly monitored in patients treated with vasopressin analogues.

Topics: Animals; Chemical and Drug Induced Liver Injury; Humans; Ischemia; Kidney Diseases; Lypressin; Shock; Skin; Terlipressin; Thrombosis; Vasoconstrictor Agents; Vasopressins; Water-Electrolyte Imbalance

Topics: Budd-Chiari Syndrome; Chemical and Drug Induced Liver Injury; Collateral Circulation; Epinephrine; Hepatic Artery; Humans; Hypertension, Portal; Hypoxia; Liver Circulation; Liver Cirrhosis; Liver Diseases; Norepinephrine; Portal System; Vasopressins; Venous Pressure

A 74-year-old man was diagnosed with nephrotic syndrome due to focal segmental glomerulosclerosis, and steroid therapy was initiated. Subsequently, he was affected by deep mycosis, and hence, voriconazole (VRCZ) was administered. On the 16th day, he was transferred to our hospital because of somnolence and malaise. His systolic blood pressure was approximately 80 mmHg, and he showed decreased skin turgor, indicating volume depletion. Laboratory analysis revealed hyponatremia and liver dysfunction. Discontinuation of VRCZ and drip infusion of normal saline improved the consciousness disorder, hyponatremia, and liver dysfunction. The levels of antidiuretic hormone (ADH) and plasma renin activity were elevated. This patient showed high excreted urine sodium, despite volume depletion and low serum osmolality. Therefore, this patient was diagnosed with salt-losing nephropathy (SLN). SLN should be considered for treatment of VRCZ-associated hyponatremia, together with syndrome of inappropriate secretion of ADH.

Topics: Aged; Antifungal Agents; Biomarkers; Chemical and Drug Induced Liver Injury; Fluid Therapy; Humans; Hyponatremia; Kidney Diseases; Liver; Male; Neurophysins; Protein Precursors; Pyrimidines; Renin; Sodium; Sodium Chloride; Time Factors; Treatment Outcome; Triazoles; Vasopressins; Voriconazole; Water-Electrolyte Balance

The concentrations of atrial natriuretic peptide (ANP), arginine vasopressin (AVP) and hormones of the renin-angiotensin axis were studied in male rats with carbon tetrachloride-induced hepatitis and the results compared to normal control animals. The rats with hepatitis exhibited lower concentrations of ANP, plasma renin activity (PRA), and angiotensin I (AI) than did the control animals. Plasma concentrations of AVP and aldosterone were not significantly different in the two groups. The results suggest that experimental hepatitis is associated with renal hyperperfusion together with reduction in atrial pressures.

Topics: Aldosterone; Animals; Arginine Vasopressin; Atrial Natriuretic Factor; Carbon Tetrachloride Poisoning; Chemical and Drug Induced Liver Injury; Liver; Male; Radioimmunoassay; Rats; Rats, Inbred Strains; Renin; Renin-Angiotensin System; Vasopressins

One of the may vital functions of the liver is the biodegradation of foreign substances. The enzyme systems responsible for this liver function are frequently the site of drug interactions, both therapeutic and detrimental. Various substances can alter these enzymes by inducing, inhibiting, or competing with them, thus affecting drug response. In most instances, the liver detoxifies and deactivates chemicals, protecting the body from their harmful effects. In some biotransformation processes, however, toxic metabolites are produced that may be injurious to liver tissue as well as other body organs and systems. The effect of alcohol on the liver is a prime example. Although significant strides have been made in recent years, much is yet to be learned concerning the effect of the liver on drugs, the effect of drugs on the liver, and the pharmacologic management of various liver diseases.

Topics: Acetaldehyde; Alcoholism; Chemical and Drug Induced Liver Injury; Diuretics; Drug-Related Side Effects and Adverse Reactions; Ethanol; Hepatic Encephalopathy; Humans; Inactivation, Metabolic; Lactulose; Levodopa; Liver; Liver Cirrhosis; Liver Diseases; Microsomes, Liver; Neomycin; Oxidation-Reduction; Pharmaceutical Preparations; Spironolactone; Vasopressins

Arginine vasopressin was infused into the V. portae and into the V. cava of unanesthetized rats in water diuresis. The differential antidiuretic response of the same animal to these infusions was used to calculate extraction fraction of ADH by the liver. In the normal rat no extraction was detected. The liver of rats hydrated with 5% ethanol extracted 10% and that of rats treated with thioacetamide extracted 60% of the ADH infused into the portal vein. It is postulated that disturbances of liver cell function by narcotics and substances causing liver damage may liberate ADH-destroying ferments into the blood.

Topics: Acetamides; Animals; Arginine Vasopressin; Chemical and Drug Induced Liver Injury; Diuresis; Ethanol; Female; Liver; Rats; Thioacetamide; Vasopressins

Topics: Adrenal Glands; Adrenocorticotropic Hormone; Arginine Vasopressin; Blood Chemical Analysis; Chemical and Drug Induced Liver Injury; Cresols; Endocrine Glands; Hepatitis; Phosphates; Potassium; Sodium; Toxicology; Urine; Vasopressins