{"id":2471,"date":"2009-08-27T12:09:42","date_gmt":"2009-08-27T12:09:42","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/gasasc\/"},"modified":"2025-05-14T19:09:17","modified_gmt":"2025-05-14T19:09:17","slug":"gasasc","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/gasasc\/","title":{"rendered":"Diagnostic Criteria for Refractory Ascites"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>Refractory ascites is defined as ascites that does not recede or that recurs shortly after therapeutic paracentesis, despite sodium restriction and diuretic treatment.<\/p>\n<p><!--more--><\/p>\n<p>For the correct diagnosis of true refractory ascites, the patient\u2019s condition should fulfill the following criteria.<\/p>\n<p><strong>Diuretic-resistant ascites<\/strong><br \/>\nFailure of mobilization or the early recurrence of ascites which cannot be prevented because of a lack of response to sodium restriction and diuretic treatment is called diuretic-resistant ascites.<\/p>\n<p><strong>Diuretic-intractable ascites<\/strong><br \/>\nFailure of mobilization or the early recurrence of ascites which cannot be prevented because of the development of diuretic-induced complications that prevent the use of an effective diuretic dosage is called diuretic-intractable ascites.<\/p>\n<p><strong>Treatment duration<\/strong><br \/>\nPatients must be on intensive diuretic therapy (spironolactone 400 mg\/d and furosemide 160 mg\/d) for at least 1 wk and on a salt-restricted diet of less than 90 mmol\/d.<\/p>\n<p><strong>Lack of response<\/strong><br \/>\nMean weight loss of less than 0.8 kg over 4 d and urinary sodium output less than the sodium intake.<\/p>\n<p><strong>Early ascites recurrence<\/strong><br \/>\nThere is an reappearance of grade 2 or 3 ascites (clinically detectable) within 4 wk of initial mobilization. However, it is important to notice that in patients with severe peripheral edema, reaccumulation of ascites within 2-3 d of paracentesis must not be considered as early ascites recurrence because it represents a shift of interstitial fluid to the intraperitoneal space.<\/p>\n<p><strong>Diuretic-induced complications<\/strong><br \/>\nDiuretic-induced hepatic encephalopathy is the development of encephalopathy in the absence of any other precipitating factor. Diuretic-induced renal impairment is indicated by an increase of serum creatinine by &gt; 100% to a value of &gt; 2 mg\/dL in patients with ascites otherwise responding to treatment.<br \/>\nDiuretic-induced hyponatremia is defined as a decrease of serum sodium by &gt; 10 mEq\/L to a serum sodium of &lt; 125 mEq\/L. Diuretic-induced hypo- or hyperkalemia is defined as a change in serum potassium to &lt; 3 mEq\/L or &gt; 6 mEq\/L despite appropriate measures.<br \/>\nIn addition to this, we should exclude dietary non-compliance (patient taking excess sodium in diet) and exclude the use of nonsteroidal antiinflammatory drugs (NSAIDs), which can induce renal vasoconstriction and diminish diuretic responsiveness<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>Hou W, Sanyal AJ. Ascites: diagnosis and management. Med Clin North Am. 2009 Jul;93(4):801-17. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/19577115\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Senousy BE, Draganov PV. Evaluation and management of patients with refractory ascites. World J Gastroenterol. 2009 Jan 7;15(1):67-80. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/19115470\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Moore KP, Wong F, Gines P, Bernardi M, Ochs A, Salerno F, Angeli P, Porayko M, Moreau R, Garcia-Tsao G, Jimenez W, Planas R, Arroyo V. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology. 2003 Jul;38(1):258-66. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/12830009\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created: Aug 27, 2009<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[53],"tags":[1415,1414,16,15,14,13,1413,1412,1416],"class_list":["post-2471","post","type-post","status-publish","format-standard","hentry","category-gastroenterology","tag-ascites","tag-ascitis","tag-criteria","tag-criterios","tag-diagnostic","tag-diagnostico","tag-gastroenterology","tag-refractaria","tag-refractory"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - 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