Removing more than 5 litres of ascitic fluid risks post-paracentesis circulatory dysfunction, which can precipitate kidney injury, hyponatraemia and rebound ascites. Intravenous human albumin, usually 6 to 8 g for every litre removed, reduces that risk.
For smaller volumes, albumin is generally not required unless the patient has acute kidney injury or other high-risk features. Diuretics should be reviewed after each large paracentesis.
- Give 6 to 8 g of albumin per litre removed when draining more than 5 litres.
- Consider albumin for smaller drains in patients with acute kidney injury.
- Check creatinine and sodium after large-volume paracentesis.
- Review diuretics after each drainage.
Why it matters
Omitting albumin after large drains is a common and preventable cause of kidney injury in cirrhosis.
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