INTRODUCTION: Acute variceal bleeding from portal hypertension is one of the most serious complications with a mortality rate of 15% to 25%. Terlipressin is a vasopressor that controls variceal bleeding by lowering the portal pressure and reducing blood flow to the varices. CASE PRESENTATION: We report a case of a patient with acute variceal bleeding, treated endoscopically and with terlipressin, who developed severe hyponatremia and seizures requiring admission to intensive care. Clinical and biochemical improvements were noticeable upon the cessation of terlipressin, with an eventual discharge from the hospital. CONCLUSION: Prompt management of acute variceal bleeding with both endoscopic and medical interventions is required. Regular biochemical monitoring is necessary while a patient is on terlipressin treatment. The duration of treatment with terlipressin should not be prolonged unnecessarily.