Q: 54 years old male with a history of cirrhosis is admitted to ICU with massive ascites, hypotension, and advanced hepato-renal syndrome. Patient requires large-volume paracentesis (LVP). Patient is allergic to albumin. Which drug can be used as an alternative to albumin in LVP?
Answer: Midodrine
Midodrine is considered an oral vasopressor that has many advantages in advanced-stage cirrhotic patients. In hospitalized patients, it has been found as an alternative or an adjuvant treatment with albumin/colloid infusion who require large-volume paracentesis (LVP).
Midodrine also has many other advantages in these patients. Being a vasopressor it increases blood pressure, improves renal perfusion, increases renal sodium excretion, reduces ascites, and is found to improve survival.
In combination with octreotide, it may reverse type I hepatorenal syndrome.
#hepatology
#pharmacology
References:
1. Singh V, Dheerendra PC, Singh B, et al. Midodrine versus albumin in the prevention of paracentesis-induced circulatory dysfunction in cirrhotics: a randomized pilot study. Am J Gastroenterol 2008; 103:1399.
2. Singh V, Dhungana SP, Singh B, et al. Midodrine in patients with cirrhosis and refractory or recurrent ascites: a randomized pilot study. J Hepatol 2012; 56:348.
3. Singh V, Singh A, Singh B, et al. Midodrine and clonidine in patients with cirrhosis and refractory or recurrent ascites: a randomized pilot study. Am J Gastroenterol 2013; 108:560.
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