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!

Treatment: 

  • 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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