Ascites

Management

• Sodium restrict < 88 mmol/day (5 g/day of salt)
• Diuretics: spironolactone 100 mg po daily + furosemide 40 mg po daily
  • Titrate up every few days, to maximum of 400 mg / 160 mg

Refractory Ascites

• Defined by urinary sodium excretion <78 mmol/24h despite maximal tolerated diuretics
  • May be limited by diuretic effects

Spontaneous Bacterial Peritonitis

• Diagnosed by ascitic fluid neutrophils >250 or culture positive
• Treat with ceftriaxone 2g q24h for 5-7 days

Further Reading

• Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012