Abstract
In adults with cirrhosis and hemorrhage from esophageal varices, infusion of vasopressin into the superior mesenteric artery (SMA) has resulted in the rapid control of bleeding, often within minutes. Three children with chronic liver disease, cirrhosis, and bleeding varices documented by fiberoptic endoscopy, received vasopressin by continuous SMA infusion. The dose of vasopressin used was 0.1 to 0.4u/min for a period of 50 to 145 hours. Despite receiving the maximal dose of vasopressin recommended for adults over a prolonged period of time, the three patients continued to have intermittent but significant bleeding requiring further blood transfusion. Transient side effects of vasopressin included mild to severe water intoxication and significant bradycardia with loss of all palpable pulses without other signs of vascular instability. Early and late complications of the transfemoral arterial catheterization in one child included paresthesias in the ipsilateral extremity within 24 hours of catheterization and severe ischemic changes 10 days later requiring three thrombectomies. The failure of continuous prolonged intraarterial vasopressin infusion to adequately control bleeding and the complications associated with this procedure suggest that the use of this therapy may not be appropriate for children with cirrhosis and varices.
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Daum, F., Zucker, P., Dinari, G. et al. FAILURE AND HAZARDS OF SUPERIOR MESENTERIC ARTERIAL INFUSION OF VASOPRESSIN FOR CONTROL OF BLEEDING VARICES IN CHILDREN. Pediatr Res 11, 443 (1977). https://doi.org/10.1203/00006450-197704000-00439
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DOI: https://doi.org/10.1203/00006450-197704000-00439
