Inclusion Criteria

 Patients presenting with sepsis admitted to the ICU and meeting all of the following criteria will be considered eligible to participate in the study:

• Age greater than or equal to 18 years.
• Able to tolerate oral medication either by mouth or by feeding tube.
• Able to give consent for participation or have representative available to give consent.
• Two or more blood pressure readings taken at least 15 minutes apart with MAPs ≤ 70 OR vasopressor use.
• Two or more points scored on SOFA.
• Treating consultant agrees to the study plan.

Exclusion Criteria: 

Patients meeting any one of the following criteria will be excluded from participation:

• Women of child bearing age with the potential to become pregnant.
• Current cardiogenic shock or KNOWN systolic heart failure with LVEF <30%.
• Current bowel ischemia.
• Recent Myocardial infarction (STEMI or Type 1 NSTEMI) within the past 3 months, evidence of active coronary ischemia or unstable cardiac rhythm.
• Current use of Monoamine Oxidase Inhibitors (MAOIs).
• Recent Stroke (within the past 3 months).
• High dose vasopressor (norepinephrine more than 0.25 microgram/kg/min).
• Lactate more than 8 mmol/L.
• Midodrine use as a home medication.
• Known allergy to midodrine.
• Fludrocortisone acetate is a current home medication.
• Contraindications to use: History of pheochromocytoma or thyrotoxicosis or Acute angle-closure glaucoma or ischemic bowel disease
• History of peripheral vascular disease requiring intervention - stent or surgery in the past 3 months.