This protocol addresses portal hypertension presenting with refractory ascites in a patient with established cirrhosis — specifically, ascites that fails to respond to intensive diuretic therapy.
The ascites is classified as diuretic-resistant when mean weight loss remains below 0.8 kg over 4 days and urinary sodium falls below sodium intake, despite maximal diuretic doses maintained for at least one week. This failure to respond defines the clinical threshold at which a different management strategy is required.
When diuretic therapy has been exhausted in a cirrhotic patient with refractory ascites, the structured regimen includes a definitive intervention targeting the underlying hepatic disease. The full sequenced protocol — including all steps, clinical decision points, and applicable options — is available below.
DOI: 10.1016/j.jceh.2022.03.002
A mean weight loss of <0.8 kg over 4 days and urinary sodium less than sodium intake in a patient with cirrhosis on intensive diuretic therapy (furosemide 160 mg/day and spironolactone 400 mg/day) for at least one week is termed as diuretic resistant ascites.
Liver transplantation remains the definitive therapy for patients with refractory ascites.
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