Removing large volumes of ascites can trigger post-paracentesis circulatory dysfunction, with hyponatraemia, kidney injury and faster reaccumulation. Intravenous albumin reduces this risk.
The usual practice is 6 to 8 g of albumin per litre removed when more than 5 litres are drained. For smaller volumes it is generally not required unless the patient has acute kidney injury or acute-on-chronic liver failure. Paracentesis is safe in most patients despite abnormal clotting tests, and routine correction with plasma or platelets beforehand is not needed.
- Give 6–8 g of albumin per litre removed when draining more than 5 litres.
- Consider albumin for smaller volumes in patients with kidney injury or acute-on-chronic liver failure.
- Do not routinely correct INR or platelets before paracentesis.
- Check sodium and creatinine after large-volume drainage.
Why it matters
Circulatory dysfunction after paracentesis is preventable and easily missed.
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