Midodrine again.

Why would a fluid physiologist want to point out that oral pills can be as effective as a drip and a bottle or three of human albumin solution?


Albumin does seem to have a beneficial effect in certain hepatology scenarios, but researchers at the University of Cairo have found a cheaper, simpler and more patient-acceptable alternative in midodrine. Tense ascites can be relieved by large-volume paracentesis, but the procedure often leads to postparacentesis circulatory dysfunction. Seventy five patients were randomised to receive intravenous albumin infusion or midodrine tablets. Patients who took midodrine for thirty days after paracentesis had higher 24-h urine sodium excretion and improved renal perfusion. 

Midodrine has also been used in perioperative care and can reduce the need for alpha agonist infusions which tie patients to higher dependency care. A small single dose was not enough for the prevention of post-surgical orthostatic hypotension, but as the authors conclude we need to better understand optimal timing and dose. https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+26492477

The MIDAS trial https://www.ncbi.nlm.nih.gov/pubmed/28327122 might help to identify broader utility.

By admin

after more than a quarter of a century of intensive care medicine consultancy in one of the UK's largest teaching hospitals Dr Woodcock is on a mission to ensure the steady state Starling principle is known and understood by every student and every practitioner.

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