We read with interest the study by Sola et al., 1 who found that 39 patients (67%) had a very alarming decrease in their serum sodium levels ! 5 mEq/L during terlipressin treatment for acute variceal bleeding (AVB). We, however, feel that some of their observations may require a closer look by the readers. Terlipressin for AVB has been evaluated in a number of studies, but hyponatremia has not been mentioned, has not been found significant, or has not been examined in most. Escorsell et al. 2 observed hyponatremia in 4 of 105 patients (3%) treated with terlipressin; similarly, Feu et al. 3 observed 5 cases of hyponatremia among 80 patients (6%) with AVB. At our center, 47 patients were treated with band ligation along with terlipressin (2 mg every 6 hours for the first 48 hours and then 1 mg every 6 hours for the next 3 days) over the last 12 months [age ยผ 50.4 6 11.9 years, hemoglobin level ยผ 8.1 6 2.1 g %, median total bilirubin level ยผ 2.3 mg % (range ยผ 1.0-27.0 mg %), serum sodium level ยผ 132.2 6 6.3 mmol/L, serum albumin level ยผ 2.5 6 0.5 g %, median serum creatinine level ยผ 0.9 mg/dL (range ยผ 0.3-5.0 mg/dL), Model for End-Stage Liver Disease score ยผ 18.4 6 7.0, and Child score ยผ 9.1 6 2.0]. None had severe hyponatremia manifesting as neurological complications. We did not find any decrease in the serum sodium level on day 1 (133.2 6 5.6 mmol/L, P ยผ 0.22); instead, we found increases in the serum sodium level on day 2 (133.9 6 5.0 mmol/L, P ยผ 0.02), day 3 (134.1 6 5.0 mmol/L, P ยผ 0.01), day 4 (134.6 6 6.5 mmol/L, P ยผ 0.03), and day 5 (135.2 6 5.7 mmol/L, P ยผ 0.007). However, we stress that albumin was given to 34 of our 47 patients (72%) because of either a low central venous pressure or an increase (>0.3 mg/dL) in the serum creatinine level from the baseline. Even a shorter course of terlipressin has been found to have equal efficacy. 4 In fact, terlipressin even improved the serum sodium level when it was given with albumin to patients with hepatorenal syndrome and severe liver dysfunction. 5 Sola et al. did not mention how many patients received albumin in the group with a !5 mmol/L decrease in the serum sodium level. Although we do respect the observations made by the Spanish group, we emphasize that before its conclusions are accepted, more prospective studies should be undertaken in patients with AVB.