Treatment of Liver Cirrhosis with Refractory Ascites
Refractory ascites in cirrhosis presents when fluid accumulation can no longer be adequately controlled
with standard medical therapy — either because the ascites cannot be mobilised, or because it recurs
too early to be satisfactorily prevented.
Clinical Scenario
The patient has liver cirrhosis complicated by refractory ascites — defined as
ascites that cannot be mobilised, or whose early recurrence cannot be satisfactorily prevented,
by medical therapy alone.
First-Line Treatment Approach
The recommended first-line intervention combines a procedural approach with albumin replacement.
Diuretic management is also addressed based on the patient's sodium excretion response.
Full regimen details, dosing, and decision criteria are in the structured protocol below.
References
DOI: 10.1016/j.jhep.2018.03.024
Repeated LVP plus albumin (8 g/L of ascites removed) are recommended as first line treatment for refractory ascites (I;1).
Diuretics should be discontinued in patients with refractory ascites who do not excrete >30 mmol/day of sodium under diuretic treatment (III;1).
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