CIRRHOSIS AND COMPLICATIONS
lege Hospital from June 2015 to july 2016. Total Number utive days were started on Midodrine 5 mg three times a
of Patients were 130. Among them 114 Chronic Hepatitis
B and 16 patients chronic Hepatitis C. Age 18–65 years.
Male 107, female 23. There were no comorbidities of these
patients.
Results: Among 130 Patients (116 Child’s Pugh A &
14 Child’s Pugh B). In HBV group Male 96, Female 18
and in HCV group Male 11, Female 05. Serum Total
cholesterol, HDL, LDL and Serum Triglyceride were done
in all patients in six monthly intervals. The results were
reduction of Serum Total Cholesterol and HDL in 45
(39.47%) and increased Serum Triglyceride in 11 (09.65%)
patients in HBV group. In HCV group increased Serum
Total cholesterol and Serum Triglyceride in 07 (43.75%)
and reduction of HDL in 03 (18.75%) patients.
Conclusion: Developing countries like Bangladesh are
likely to face an enormous burden of CLD and prevention
and early diagnosis is essential to reduce economic loss and
health system burden. Dyslipidemia is frequent in CLD &
found with severity of the disease. Moreover, it may acts
as a good predictor of CLD management. Till now, no
needful studies are available in Bangladesh.
Understanding the pattern of Dyslipidemia of hepatitis
B & C related CLD in Bangladesh may enrich the clinician
and may act as a baseline study for further research.
CIRRHOSIS AND COMPLICATIONS
CONFLICTS OF INTEREST
The authors have none to declare.
http://dx.doi.org/10.1016/j.jceh.2018.06.364
4 WILSON’S DISEASE: THE SPECTRE OF
MIDODRINE FOR DIURETIC
INTRACTABLE ASCITES WITH
HYPONATREMIA
Pathik Parikh
Zydus Hospitals, Ahmedabad, India
E-mail address: pathik269@gmail.com.
Background and Aims: Midodrine hydrochloride is
an orally available, ␣-adrenergic agonist that increases
effective circulating blood volume and renal perfusion by
increasing systemic and splanchnic blood pressure. There
is scanty data besides the study from North India, on use
of midodrine in patients with cirrhosis and ascites with
an additional component persistent hyponatremia and
hypotension.
Methods: In this single center observational study
patients with diuretic intractable ascites (EASL crite-
ria) with persistent hyponatremia (Serum Sodium
<130 mEq/L) even after withholding the diuretics and
albumin replacement (100 ml 20% per day) for 3 consec-
S52
day. The dose was increased to 7.5 mg three times a day at
the end of 7 days if mean arterial pressure (MAP) remained
less than 80. Tolvaptan 15 mg once a day was added at 15
days if serum sodium remained <125 mEq/L at 2 weeks. We
excluded patients if there was proven sepsis or renal dys-
function (serum creatinine 1 mg/dl). Serum sodium was
measured every week.
Results: Ten patients were included (7 NASH, 3 ALD).
The Mean age was 49 ± 2.1 years, with pretreatment MAP
73 mm of Hg (Range 70–78) serum sodium of 127 mEq/L
(Range 118–130). At the end of six weeks, 6 patients were
on 5 mg dose while 4 patients were on 7.5 mg dose. Only
one patient required tolvaptan for 14 days (stopped once
serum sodium reached 140). The mean arterial pressure
was 86 mg of Hg (P < 0.05) and mean serum sodium levels
were 136 mEq/L (Range 132–139) (p < 0.05). We were able
to reintroduce low dose diuretics in 4 patients.
Conclusions: Midodrine use can successfully reverse
hyponatremia related diuretic intractable refractory
ascites in 40% cases besides significantly improving serum
sodium levels and mean arterial blood pressures.
CONFLICTS OF INTEREST
The author has none to declare.
http://dx.doi.org/10.1016/j.jceh.2018.06.365
5
STROKE IN A YOUNG PATIENT WITH
‘RE BALANCED HEMOSTASIS’
Khalid Javid, Sridhar Cg ∗ , Juned Khan,
Ramesh Kumar Ts, Ramcharan Reddy
GEM Hospital and Research Center, Coimbtore, Tamil Nadu, Coimbatore, India
E-mail address: drkhalidjavid@gmail.com (S. Cg).
Background: Coagulopathy is an essential component
of the liver cell failure and reflects the central role of liver
function in hemostasis.
Case Summary: We present a seven-year old boy, a
known case Wilson’s disease who presented with jaundice
and abdominal distension for two weeks with history of
repeated episodes of hypoglycemia for last five days. He
was on Penicillamine 500 mg thrice daily. On examination
he was found to have chronic liver disease, decompen-
sated with grade I hepatic encephalopathy and minimal
ascites. Laboratory investigations showed thrombocy-
topenia (64,000/mm3 ), Blood sugar of 52 mg/dl, Serum
albumin; 2.5 mg/dl, Bilirubin; 17 mg/dl, Serum Alanine
transaminase; 52 IU/L, Aspartate transaminase; 153 IU/L,
Alkaline phosphatase; 211 IU/L, and international nor-