Treatment of Ascites with Serum Sodium Below 120 mmol/l While on Diuretic Therapy

Clinical Scenario

This protocol addresses a specific and critical presentation: a patient already receiving diuretic therapy for ascites who is found to have a serum sodium below 120 mmol/l. At this level, the standard diuretic approach to ascites management requires immediate reassessment.

Key Finding

Serum sodium < 120 mmol/l in a patient currently on diuretics for ascites. This threshold defines a situation where ongoing diuretic therapy can no longer be continued in its current form, and active intervention is required to address the low sodium safely.

Approach Overview (Partial)

Management centres on a change to the diuretic regimen, followed by volume expansion with an appropriate fluid. Crucially, correction of serum sodium must be carefully controlled — the rate of rise over any 24-hour period is a key constraint that guides therapy. The complete algorithm, including specific fluid selection and monitoring parameters, is in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

Serum sodium <120 mmol/l, stop diuretics.
We believe that most patients should undergo volume expansion with colloid (haemaccel, gelofusine, or voluven) or saline.
However, avoid increasing serum sodium by >12 mmol/l per 24 hours.

DOI: 10.1136/gut.2006.099580

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