Exam III: Ascites Flashcards
What is the most common complication of cirrhosis?
Ascites
_______ is used to detect the presence of ascites. However, it does not detect the cause.
Abdominal Ultrasound
A SAAG >1.1 grams/dL indicates ______.
Portal Hypertension
When should abdominal paracentesis be avoided?
When bleeding risk is high:
Elevated INR or Prothrombin Time
What is the recommended daily sodium intake for ascites patients?
<2 grams/day
Should you restrict fluids to reduce ascitic build up?
No
What is the common aldosterone antagonist used to treat ascites?
Spironolactone
What is the loop diuretic commonly used with spironolactone to treat ascites?
Furosemide
Ideal Spironolactone-Furosemide Ratio
100 mg-40mg
Why is furosemide used with spironolactone?
To reduce the risk of hyperkalemia caused by spironolactone.
Why should you never use thiazide diuretics in ascites?
They increase the risk of hyponatremia.
How should we manage an ascite patient with low BP?
Start with 50 mg spironolactone. Monitor then see if we can add furosemide.
If a patient can not tolerate diuresis what should be added?
Midodrine (7.5 mg TID)
If a patient can not tolerate midodrine, what should be added next?
Large Volume Paracentesis (removal of 4-8 L of fluid every 2 weeks.)
What do we need to monitor after parencentesis?
BP
SCr
