Original Contribution
The American Journal of Gastroenterology (2008) 103, 1399–1405; doi:10.1111/j.1572-0241.2008.01787.x
Midodrine Versus Albumin in the Prevention of Paracentesis-Induced Circulatory Dysfunction in Cirrhotics: A Randomized Pilot Study
Virendra Singh MD, DM1, Prashant C Dheerendra MD2, Baljinder Singh MSc, PhD3, Chander K Nain MSc, PhD4, Divya Chawla MSc3, Navneet Sharma MD2, Ashish Bhalla MD2 and Sushil K Mahi MD2
- 1Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- 2Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- 3Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- 4Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Correspondence: Virendra Singh, MD, DM, Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.
Received 4 June 2007; Accepted 3 December 2007.
Abstract
OBJECTIVES:
Intravenous albumin has been used to prevent paracentesis-induced circulatory dysfunction (PICD) in cirrhotics; however, its use is costly and controversial. Splanchnic arterial vasodilatation is primarily responsible for PICD. There are no reports of use of midodrine in the prevention of PICD. In this pilot study, we evaluated midodrine and albumin in the prevention of PICD.
METHODS:
Forty patients with cirrhosis underwent therapeutic paracentesis with midodrine or albumin in a randomized controlled trial at a tertiary center. Effective arterial blood volume was assessed by plasma renin activity.
RESULTS:
Plasma renin activity at baseline and at 6 days after paracentesis did not differ in the two groups (43.18 
10.73 to 45.90 8.59 ng/mL/h, P= 0.273 in the albumin group and 44.44 8.44 to 41.39 10.21 ng/mL/h, P= 0.115 in the midodrine group). Two patients had an increase in plasma renin activity of more than 50% from baseline in the albumin group, and none in the midodrine group. A significant increase in 24-h urine volume and urine sodium excretion was noted in the midodrine group. Midodrine therapy was cheaper than albumin therapy.
CONCLUSIONS:
The study suggests that midodrine may be as effective as albumin in preventing PICD in cirrhotics, but at a fraction of the cost, and can be administered orally. Midodrine also resulted in an increase in 24-h urine volume and sodium excretion.
