To the Editor.— Demeclocycline causes diuresis of ascitic fluid in cirrhotic patients. 1 A major side effect, however, is renal insufficiency caused by an uncertain pathophysiologic mechanism. 2 Recently a 66-year-old woman with severe ascites came to us afflicted by symptoms of hypovolemia: postural dizziness, dry mouth, excessive thirst, and intractable headaches. For two years a diet restricted to 850 ml of fluid and 45 mEq of sodium, together with a regimen of furosemide (80 mg three times a day), hydrochlorothiazide (25 mg twice a day), and spironolactone (25 mg twice a day), had kept the ascites to a barely tolerable limit (abdominal girth of 106.7 cm and large abdominal hernia). She was unable to carry on even routine self-care activities such as putting on stockings and shoes. Results of physical examination showed substantial orthostatic changes in blood pressure (decrease of 20 mm Hg systolic and 10 mm Hg diastolic)