Removing large volumes of ascitic fluid can trigger post-paracentesis circulatory dysfunction, with renal impairment, hyponatraemia and reaccumulation of ascites. Established guidance from bodies including EASL and AASLD is to give intravenous albumin when more than about five litres are removed, at around 6–8 g per litre drained.
For smaller volumes, routine albumin is not usually required, but it is reasonable in patients with acute kidney injury or acute-on-chronic liver failure.
- Give intravenous albumin, about 6–8 g per litre removed, when draining more than five litres.
- Check creatinine and sodium after large-volume paracentesis.
- Send ascitic fluid for cell count at every tap to look for spontaneous bacterial peritonitis.
- Review diuretics and salt intake after each tap to reduce the need for the next.
Why it matters
The harm of a large tap often appears days later as kidney injury.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for gastroenterology & hepatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free