Treatment of Ascites

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

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