Ascites

In general ascitic fluid should be tested for the following

WBC and differential.
Albumin.
Culture - fluid placed in blood culture bottles.
Amylase.
Cytology.
Request TB culture, ZN stain and PCR if this infection is suspected.

The serum-to-ascites albumin gradient (the serum albumin minus the albumin level in the ascitic fluid) is very useful. If >11 this makes portal hypertension the likely cause.

Management of ascites should consist of a low salt diet, spironolactone 50-200 mg daily with or without frusemide aiming for a weight loss of 0.5 - 1 kg/day. Remove ascitic fluid by peritoneal tap, if necessary combined with IV albumin infusion. Give a minimum of 10 g albumin for every litre of ascitic fluid removed.

Spontaneous bacterial peritonitis is likely with an ascitic fluid white count of >250 x 10⁶/L with neutrophils predominant. The initial treatment for proven or suspected bacterial peritonitis is cefotaxime 1 g q6h IV (use higher dose if the patient is unwell) or ceftriaxone 2 g IV q24h, and albumin 1.5 g/kg ± further dose of 1 g/kg on day 3.


Information about this CDHB document (1426):
Document Owner:	Blue Book Editorial Committee (see Who's Who)
Issue Date:	December 2013
Next Review:	December 2015
Keywords:
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Topic Code: 1426