Refractory Ascites

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• In a series of review articles, has popularized the standard algorithm used for the treatment of ascites. • The initial treatment is restriction of dietary sodium intake to 88 mmol/day and oral diuretic therapy. • The combination of spironolactone and furosemide is the most effective diuretic regimen. The typical starting daily dose is 100 mg of spironolactone and 40 mg of furosemide, with all medications taken once in the morning. • The use of divided doses is not supported by pharmacokinetic data, and compliance is much better with a single daily dose. If there is no decrease in body weight or increase in urine sodium excretion after 3 days and up to 1 week, the doses of both drugs can be doubled to 200 mg/day of spironolactone and 80 mg/day of furosemide.
• The maximum daily doses are 400 mg of spironolactone and 160 mg of furosemide. An alternative strategy is to substitute amiloride for spironolactone at a starting dose of 10 mg/day, increasing to a maximum of 40 mg per day, but amiloride is more costly and this regimen is somewhat less effective than spironolactone and furosemide.
Page 1 and 2: Refractory Ascites prof. Dr. Ali El
Page 3 and 4: Refractory ascites is defined as as
Page 5 and 6: Second, in some studies bedrest has
Page 7 and 8: 1. diuretic-resistant ascites -- as
Page 9 and 10: 1-Diuretic-resistant ascites Failur
Page 11 and 12: 5-Early ascites recurrence There is
Page 13: Treatment The ideal treatment of as
Page 17 and 18: • Multiple studies show better co
Page 19: • Sodium restriction is indeed an

Refractory Ascites

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