Liver Cirrhosis with Grade 2 Ascites — Next Step When Furosemide Has Not Achieved Target Weight Reduction
This protocol covers patients with liver cirrhosis experiencing a first episode of grade 2 (moderate) uncomplicated ascites who have undergone stepwise diuretic escalation but have not reached the expected response threshold.
The prior treatment involved furosemide at increasing doses (stepwise escalation). That line required a body weight reduction of at least 2 kg per week — a target that was not met — prompting escalation to this protocol.
When furosemide produces a weak diuretic response in this setting, an alternative loop diuretic agent may be considered. The complete management algorithm, dosing approach, and clinical decision pathway are available in the full protocol.
References
DOI: 10.1016/j.jhep.2018.03.024
Patients with the first episode of grade 2 (moderate) ascites should receive an anti-mineralocorticoid drug alone, starting at 100 mg/day with stepwise increases every 72 h (in 100 mg steps) to a maximum of 400 mg/day if there is no response to lower doses (I;1).
Torasemide can be given in patients exhibiting a weak response to furosemide (I;2).
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