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

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.