Presentation in rounds by Dr Amy Hills:
Prognosis: Treatment does not improve survival. But…it makes the patient feel better, may lower risk of SBP and cellulitis of the abdomen, and the patient expends fewer calories heating the fluid!
- Consider diagnostic/therapeutic paracentesis.
- Stop drinking EtOH!
- < 2 gram NaCl restriction
- Fluid restrict if Na < 125 mg/dL
- Caution with IVF
- Increase renal perfusion:
- Stop/caution with ACEI/ARBs
- Avoid NSAIDs
- Avoid beta-blockers (which can INCREASE mortality! – but, the patient may need these for varices or portal HTN…)
- Spironolactone:furosemide in 100mg:40mg ratio (can do 50:20 up to 400:160)
- Monitor BPs closely
- Monitor renal function closely (avoid hepatorenal syndrome!)
- Consider IV albumin, liver transplant, TIPS procedure
- Other options:
- Midodrine for refractory ascites
- Avoid elective surgeries until ascites controlled