Post-paracentesis midodrine, instead of albumin?

The efficacy of post-paracentesis IV albumin for the prevention of circulatory dysfunction is debatable, and carries a Grade II recommendation from the AASLD in patients undergoing high volume paracentesis (>5L) (guideline). In search of alternative agents, this small pilot randomized 40 cirrhotics with tense ascites undergoing paracentesis to oral midodrine (5-10mg q8 for 3 days) or IV albumin (8g per liter removed). Circulatory dysfunction (defined as >50% increase in renin activity) occurred in 2 albumin patients and no midodrine patients. The authors conclude midodrine may be as effective as albumin in preventing post-paracentesis circulatory dysfunction. In addition, it is less expensive, more readily available, and can be given orally. Although not ready for prime time, stay tuned for larger confirmatory studies (abstract).

Danielle Scheurer

Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.

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