IDDF2022-ABS-0251 A prospective observational study to assess the efficacy and outcome of octreotide and midodrine in the treatment of cirrhosis associated hyponatremia

BackgroundHyponatremia in cirrhosis patients is associated with increased morbidity and mortality. A combination of midodrine, an alpha agonist, and octreotide, a somatostatin analogue, have both been previously proven beneficial in HRS (Hepatorenal Syndrome). We hypothesized that it may improve cirrhosis-associated hyponatremia.MethodsThis single-centred prospective observational study included 28 patients who were placed on 1-litre fluid restriction and albumin infusion of 1g/kg up to a maximum of 100g for 2 days to exclude hypovolemic hyponatremia. Patients with non-improvement with albumin challenge for 48 hours were then given Midodrine 10mg thrice a day (max 45mg) and Octreotide 100mcg (max 200mcg intravenous). We studied the change in serum sodium concentration, and urinary EFWC (Electrolyte Free Water Clearance) before and after treatment.ResultsAll the baseline characteristics age, gender, etiology, comorbidities and months since diagnosis of cirrhosis was assessed. There was statistically significant improvement seen in the serum sodium (IDDF2022-ABS-0251 Table 1, IDDF2022-ABS-0251 Figure 1. Serum sodium level before and after treatment), Urinary volume and EFWC. A 28-day follow-up of all patients in the study population was done, and it was found that 7 out of 28 patients died.Abstract IDDF2022-ABS-0251 Table 1Serum Sodium level before and after treatment Serum Sodium level at baseline (mmol/L) Number Of Patients(%) Serum Sodium Level after treatment (mmol/L) Number of Patients(%) 113–115 1(3.57%) 126–127 2(7.14%) 116–118 0(0%) 128–129 2(7.14%) 119–121 1(3.57%) 130–131 8(28.5%) 122–124 6(21.42%) 132–133 6(21.42%) 125–127 6(21.42%) 134–135 5(17.85%) 128–130 14(50%) 136–137 3(10.71%) 138–139 2(7.14%) Abstract IDDF2022-ABS-0251 Figure 1ConclusionsIn our study, Octreotide and Midodrine significantly improved hyponatremia in cirrhosis-associated ascites patients. Further larger randomized, controlled clinical trials are required to validate our findings.