Ascites Case 1
You are rounding with your team post-call.
Mr. JK is a 64 year old man admitted for therapeutic paracentesis.
He was diagnosed with cardiac ascites 18 months ago and despite extensive medications, requires therapeutic tap q4-6 weeks. He had increase in Furosemide to 120 mg BID in clinic visit 10 days ago.
Since discharge 1 month earlier, patient notes gradual increase in weight, now 16 lbs over discharge weight, with increasing abdominal girth and LE edema. He has weeping of fluid from leg distension. He is uncomfortable with breathing in supine position, otherwise denies dyspnea. No reported abdominal pain, fever, chills or bleeding sx.
| PMH: | Paranoid ideation; chronic atrial fibrillation; previous warfarin anticoagulation x 2 years resulted in labile INRs; documented fall to head; discontinued 3m ago. |
|---|---|
| Meds: | include ACE-Inhibitor, furosemide, spironolactone, b-blocker, ASA |
| Social: | Medications are managed by patient’s son, who is his caregiver since the patient left a NH 4 months ago and refuses placement. Attempts to arrange elective taps in ER or same day unit have been unsuccessful. |
| Exam on admission: | |
| BP: | 98/54 |
| HR: | 106, irreg irreg |
| Resp: | 20 |
| Wt: | 168 lbs. |
| General: | Pt alert, sallow skin color, obviously distended abdomen and anasarca |
