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).
This large systematic review found rectal NSAIDs significantly reduced the risk of post-ERCP pancreatitis compared to pancreatic duct stents (abstract).
This large population-based cohort found the most common causes of drug induced liver injury to be augmentin and diclofenac, followed by herbal and nutritional supplements (abstract).
This large trial of patients with a relative contraindication for enteral feeds were randomized to early TPN or usual care. There were no differences in the groups in 60 day mortality or LOS, but those on TPN did have a shorter time ventilated and less muscle/fat loss. It is unclear based on this trial if […]