Removing a large volume of ascites in one sitting can trigger circulatory dysfunction, with renal impairment, hyponatraemia and higher mortality. Intravenous albumin given with large-volume paracentesis reduces this risk and is standard practice.
The usual approach is albumin replacement for each litre removed once the volume exceeds about five litres. Check renal function and sodium afterwards, particularly in patients with refractory ascites.
- Give intravenous albumin when more than about five litres of ascites are drained.
- Check creatinine and sodium after large-volume paracentesis.
- Send ascitic fluid for cell count at every tap to look for spontaneous bacterial peritonitis.
- Review diuretic doses and salt intake after each drainage.
Why it matters
Post-paracentesis circulatory dysfunction is preventable and often overlooked.
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