Sodium restriction (20-30 mEq/d) and diuretic therapy constitute the standard medical management for ascites and are effective in approximately 95% of patients. Note the following: Water restriction is used only if persistent hyponatremia is present (see Diet, below).
Moderate sodium restriction (2 g or 90 mmol/day) and diuretics (spironolactone with or without furosemide) are the first-line treatment in patients with cirrhosis and grade 2 ascites.
Restrict sodium and fluid intake as indicated.
Patients with ascites often develop hyperaldosteronism resulting in increased sodium reabsorption by the renal tubules. Sodium restriction is the standard medical management for ascites. Water restriction is essential if persistent hyponatremia is present.
Fluid restriction is not necessary in treating patients with cirrhosis and ascites unless the serum sodium is <120 mmol/L. The usual diuretic regimen for cirrhotic ascites consists of spironolactone 100 mg and furosemide 40 mg.
G&H How is ascites usually treated? LJ Ascites is most commonly treated with a diuretic, which removes the fluid from the abdomen. The most common such agent is spironolactone (Aldactone, Pfizer), with furosemide (Lasix, Hoechst) frequently used as an adjuvant.
Treatments for ascites can help improve symptoms and reduce complications. In some patients, ascites may resolve with diuretic therapy or with TIPS or liver transplant. In the case of alcohol-associated hepatitis, ascites may resolve with improvements in liver function.
But sometimes a provider must drain the fluid from the belly using a special needle. View our Ascites Patient Fact Sheet for more information. If you have ascites and you suddenly get a fever or new belly pain, go to the emergency room immediately.
47 Many hepatologists do recommend fluid restriction of between 1 and 1.5 L/day in presence of severe hyponatraemia (serum sodium <125 mmol/L).
Nurses to monitor body weight, abdominal girth, prevent deep vein thrombosis, encourage ambulation and educate the patient and family about the importance of a low sodium diet. Internist to monitor coagulation parameters and general health of the patient.
Possible Complications
Complications may include: Spontaneous bacterial peritonitis (a life-threatening infection of the ascitic fluid) Hepatorenal syndrome (kidney failure) Weight loss and protein malnutrition.
Your doctor can put a small tube into the abdomen to drain off the fluid. This reduces the swelling and makes you feel more comfortable. It's called abdominal paracentesis (pronounced para-sen-tee-sis) or an ascitic tap (pronounced ass-it-ic tap).
The fluid causes swelling that can make the tummy feel tight and very uncomfortable. It often develops over a few weeks but might happen over a few days.
Common problems with ascites that keeps coming back are leg swelling, breathing difficulty and intestine blockage. Resting in a reclined position with the feet up lowers pressure on the internal organs, improves blood flow and helps drain the fluids.
Patients with severe ascites can be positioned supine. Patients with mild ascites may need to be positioned in the lateral decubitus position, with the skin entry site near the gurney.
2) Moderate ascites (grade 2) can be detected on physical examination. The fluid volume is usually >500 mL. 3) Severe ascites (grade 3) causes abdominal distension accompanied by flattening of the umbilicus or umbilical hernia. Dyspnea indicates that the peritoneal fluid volume is large, up to ~5 to 15 L.
A normal person will produce a urine volume of somewhere between 1 to 2 liters per day, whereas cirrhotic patients with liver decompensation and ascites probably will only produce 300 to 500 mL per day due to severe salt and water retention.
Ascites is the abnormal build-up of fluid in the abdomen. Technically, it is more than 25 ml of fluid in the peritoneal cavity, although volumes greater than one liter may occur. Symptoms may include increased abdominal size, increased weight, abdominal discomfort, and shortness of breath.
The probability of survival at one and five years after the diagnosis of ascites is approximately 50 and 20%, respectively, and long-term survival of more than 10 years is very rare [8]. In addition, mortality rises up to 80% within 6–12 months in patients who also develop kidney failure [1].
It usually takes between 5 and 15 minutes. When the fluid stops draining you remove the bottle and put a cap over the end of the tube.
The classification of ascites is based on the amount of fluid in the abdominal cavity: grade 1 ascites, or mild ascites, detectable by ultrasound examination; grade 2 ascites, or moderate ascites, characterized by a mild symmetrical abdominal distension; and grade 3 ascites, or large ascites, with significant abdominal ...
It is recommended that the drainage frequency not exceed three times per week.
Can ascites be reversed? With treatment, ascites can be temporarily reversed. But over time, more invasive treatments will be needed to temporarily reverse ascites. Eventually, most people with ascites will need a liver transplant.