Treatment of cirrhosis-associated hyponatremia with Midodrine and Octreotide

Background: Hyponatremia in the setting of cirrhosis is a common electrolyte disorder with few therapeutic options. The free water retention is due to non-osmotic vasopressin secretion resulting from the cirrhosis-associated splanchnic vasodilatation. Therefore, vasoconstrictive therapy may correct this electrolyte abnormality. The aim of this study was to assess the efficacy of midodrine and octreotide as a therapeutic approach to increasing urinary electrolyte-free water clearance (EFWC) in the correction of cirrhosis-associated hyponatremia. Methods: This observational study consisted of 10 patients with cirrhosis-associated hyponatremia. Hypovolemia was ruled out as the cause of the hyponatremia with a 48-h albumin challenge (25 g IV q6 h). Patients whose hyponatremia failed to improve with albumin challenge were started on midodrine and octreotide at 10 mg po tid and 100 mu g sq tid, respectively, with rapid up-titration as tolerated to respective maximal doses of 15 mg tid and 200 mu g tid within the first 24 h. We assessed urinary EFWC and serum sodium concentration before and 72 h after treatment. results: Pretreatment serum sodium levels ranged from 119 to 133 mmol/L. The mean pretreatment serum sodium concentration +/- SEM was 124 mmol/L +/- 1.6 vs 130 mmol/L +/- 1.5 posttreatment (p = 0.00001). The mean pretreatment urinary EFWC +/- SEM was 0.33 L +/- 0.07 vs 0.82 L +/- 0.11 posttreatment (p = 0.0003). conclusion: Our data show a statistically significant increase in serum sodium concentration and urinary EFWC with the use of midodrine and octreotide in the treatment of cirrhosis-associated hyponatremia.