Background: About half of cirrhotic patients develop ascites. Large volume paracentesis or trans
internal jugular portosystemic shunt are alternatives in patients with refractory
ascites. Intravenous (IV) loop diuretics are not routinely recommended for the treatment
of cirrhotic ascites. We audited our experience with the use of IV furosemide and
IV human albumin for the treatment of cirrhotic ascites that did not respond to oral
diuretics and salt restriction. We also assessed the treatment side effects and patient's
outcomes. Patients and Methods: Study subjects were selected from patients who were admitted for management of moderate
or massive cirrhotic ascites refractory to oral diuretics and salt restriction. Patients'
characteristics were documented. Renal function and electrolytes were measured on
admission and daily thereafter. All patients were treated with IV furo-semide at 40-60
mg TID, human albumin at 100ml of 20% (20gm) per day and spironolactone at 150-400
mg daily. We recorded complications and mortality during these admissions. Results: Fifty admission episodes for 28 patients were evaluated. The mean age was 58 ± 5
years. In 32 admissions, the ascites responded to the treatment regimen and Large
volume paracentesis (LVP) was not required. The mean serum creatinine was 132 ± 17
μmol/l. High urine sodium was an indicator of response, with a mean of 71±14 mmol/l.
Mild renal impairment was the most common complication (53.3%). The mean duration
of hospital stay was 9.2 ± 2.3 days. Seven patients died from sepsis and hepatorenal
syndrome type 1. Conclusions: Closely monitored use of IV furosemide with human albumin for treatment of cirrhotic
ascites is effective and superior to oral diuretics, and it may reduce the need for
LVP.
Key-words:
Hyponatremia - Renal impairment - Hypokalemia - Spironolactone - Hepatorenal syndrome.
