HWN Suggests

Octreotide in the ED

Octreotide is frequently used in the ED for patients with a history of cirrhosis who present with a moderate or severe upper GI bleed presumed to be from a variceal source. Octreotide inhibits the release of glucagon, which is a splanchnic vasodilator. It therefore reduces splanchnic blood flow and portal venous pressure. The effect on portal pressure, however, is transient, lasting about five minutes even when used as an infusion [1], though it may continue to reduce intestinal blood flow for longer through other mechanisms.

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Articles of Interest

EM@3AM: Gastroesophageal Varices

Use octreotide 50 mcg IV bolus, 50 mcg/hr IV infusion (or vasopressin with nitroglycerin), which is associated with decreased products transfused.

Octreotide and Somatostatin for Undifferentiated Upper Gastrointestinal Bleed

Until newer studies are published showing either harm or no clinical benefit, at this time the use of octreotide in non-variceal upper gastrointestinal hemorrhage appears to benefit bleeding and need for surgery (Especially in the sickest patients: Hemodynamically unstable, requiring transfusion, large volume hematemesis). Unfortunately, we just do not have mortality data to help guide this decision nor do we know the optimal length of time to continue the infusion.

When to use octreotide for upper GI bleeding

Octreotide is a long-acting analog of somatostatin. It inhibits the release of many endocrine peptides including insulin and glucagon. In addition, it inhibits the release of gastric acid. Because glucagon is a vasodilator, octreotide indirectly decreases splanchic blood flow by its action inhibiting the release of glucagon. The best data for the use of octreotide is in variceal bleeding. It does not provide a benefit in terms of decreased mortality, but it does affect other meaningful outcomes.

Resources

GI Bleeding

Octreotide should be provide immediately on an empiric basis if varices are considered a possibility. If a variceal hemorrhage is possible, give octreotide (50 microgram bolus followed by 50 mcg/hr infusion). This is safe, when in doubt just give it.