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Intravenous albumin is recommended for the prevention of paracentesis-induced circulatory dysfunction (PICD) or renal failure in cirrhotic patients with tense ascites who are undergoing large-volume paracentesis. However, the use of IV albumin is still hotly debated, especially considering its high cost and limited availability due to manufacturing shortages. Might the vasoconstrictor midodrine represent another option?
To find out, researchers conducted a pilot study among 40 cirrhotic patients with tense ascites who required repeated paracentesis. Patients were randomized to receive midodrine (5–10 mg orally every 8 hours for a total of 72 hours to maintain mean arterial pressure at 10 mm Hg greater than baseline) or IV albumin (8 g/L of a…