Ascites

Himali Meshram
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MANAGEMENT
The use of diuretics and salt restricted diet form the mainstay of treatment in children with mild to moderate ascites.1,2 Fluid restriction is helpful when serum sodium is less than 120 mEq/liter

Diuretics1
1. Spironolactone: 2 to 3 mg/kg/day. Contraindicated in hyperkalemia, renal failure.
2. Frusemide: 1 to 2 mg/kg/dose; maximum: 6 mg/kg/dose. Contraindicated in dyselectrolytemia, anuria, hypersensitivity.
3. Metolazone – useful in congestive heart failure. Dose: 5 to 20 mg/dose once a day. Contraindicated if hypersensitivity or anuria

Drugs contraindicated in ascites:
1. NSAIDS – considering risk of further sodium retention, renal failure
2. ACE inhibitors, angiotensin II antagonist or alpha1-adrenergic receptor blocker – they decrease arterial pressure, renal blood flow and are at increased risk to cause renal failure.

Diuretic-Resistant Ascites 1,2
In children with large ascites or not responding to medical treatment following options can be considered:
1. Therapeutic large volume paracentesis with albumin infusion
2. LeVeen or Denver (peritoneovenous) shunt
3. Transjugular intrahepatic portosystemic stent shunt (TIPS)
4. Liver transplantation if ascites due to chronic liver disease (tomar).

References
Ascites Ascites 10/02/2019
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