Penile Gangrene Following Use of Midodrine Hydrochloride for Hypotension in a Male Diabetic Patient Undergoing CAPD

A 74 year old diabetic nephropathy patient had symptomatic postural hypotension with normal left ventricular function. As there was no significant response to discontinuation of antihypertensives, he was started on midodrine hydrochloride, which led to a significant symptomatic improvement. After 3 weeks, he developed a gangrenous patch over his glans penis. A Doppler ultrasound showed deceased blood flow in the penile artery. The penile artery which was probably already undergoing arteriosclerotic changes, deteriorated further due to vasoconstriction. Midodrine hydrochloride has to be cautiously used in dialysis patients.