In liver cirrhosis complicated by long-standing or recurrent ascites, the standard first-line strategy aims for defined weight-loss targets through combined diuretic therapy and dietary sodium restriction. When those targets are not met, a structured next-line protocol applies.
This protocol is specific to patients with liver cirrhosis who present with long-standing or recurrent ascites — a complication that requires systematic management to achieve adequate and sustained fluid control.
The established initial approach is a combination of an anti-mineralocorticoid drug and furosemide, with doses increased sequentially according to the response, together with moderate dietary sodium restriction. The defined target is body weight reduction of at least 2 kg per week, with a daily maximum of 0.5 kg in patients without oedema and 1 kg/day in those with oedema. Failure to achieve this weight-reduction target is the escalation criterion for this next-line protocol.
An alternative diuretic agent may be considered in patients who show a weak response to furosemide. The complete selection criteria, dosing strategy, and treatment algorithm are available in the full protocol.