Ascites

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Ascites is the pathologic accumulation of fluid in the peritoneal cavity, and its most common cause is  cirrhosis. 

Pharmacological Treatment 

C: spironolactone (PO) 50mg – 400mg 24hourly incrementally till ascites resolves 

OR  

S: eplerenone (PO) 50mg 24hourly 

AND 

B: furosemide (PO) 40mg–160 mg 24hourly or in divided doses incrementally till ascites resolves 

AND 

A: propranolol (PO) 40mg–160mg 12hourly daily incrementally target heart rate 55-60bpm. 

OR 

C: carvedilol (PO) 6.25mg 24hourly, increase to 6.25mg (PO) 12hourly unless persistent arterial hypertension, SBP should not decrease <90mmHg.   

AND 

S: albumin 25% (IV) – in refractory ascites and large volume paracentesis. Give 25g stat, repeat at 15–30min Interval at Max Dose of 250g/48hourly  

Note: 

• Consider  discounting  βB  if  SBP  <90  or  MAP  ≤82  mmHg,  serum  Na  <120  mEq/L,  AKI, HRS, SBP, sepsis, severe alcoholic hepatitis, poor follow-up.
• Large-volume  paracenteses  (LVP;  >5  L  fluid  removal):  give  6–8g  albumin  per  L  fluid removed  (above  5  L)  as  colloid  replacement  is  associated  with  decreased  risk  of  post- paracentesis circulatory dysfunction and possibly decreased mortality.