Management of Ascites Caused by Cirrhosis

You answered:

B Restrict the patient’s fluid intake to 1 liter a day to correct hyponatremia and continue current diuretic doses for another week to see if ascites improves.

This answer is incorrect. If one checked a 24-hour urine for creatinine clearance, it would likely be less than 50 ml/min. Cirrhotic patients typically have low muscle mass, which is typically reflected by low creatinine levels. As a rule of thumb, cirrhotics with serum creatinine levels above 1.0 have some level of renal insufficiency. Although the fluid restriction would improve the hyponatremia, it would worsen renal function.

Choose another answer:

A Slowly increase diuretics further with close laboratory monitoring.
C Stop diuretics, perform large volume paracentesis as needed to control ascites, and refer for evaluation of possible liver transplantation.
D Proceed with a transjugular intrahepatic portosystemic shunt (TIPS) procedure to manage the refractory ascites.

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