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Excess fluid in the abdominal cavity can cause significant discomfort and shortness of breath. The method of treatment depends upon the reason for the ascites accumulation, how quickly the fluid has accumulated, whether it is a first occurrence or a repeated event, and how significantly the symptoms affect the patient.
Lifestyle Changes and Medication
For patients with cirrhosis, the initial therapy for ascites begins with dietary salt restriction and medications to assist the body in ridding itself of excess salt and fluid. Spironolactone (Aldactone) is a first line diuretic medication that helps block the chemical aldosterone which is responsible for salt retention in the body. Furosemide (Lasix) and metolazone (Zaroxolyn) may also be added. This treatment is effective in controlling ascites fluid in the vast majority of patients.
Body weight is used as a measurement of ascites control. The goal for diuretic therapy is to lose between one to two pounds of weight per day depending upon underlying medical conditions. Once most of the ascites fluid is gone, medication dosing will be individualized to the patient's needs.
Water restriction may be considered if hyponatremia, (low serum sodium) is present.
Paracentesis: If diuretics and diet fail, paracentesis may be the next step in the treatment offered. Under sterile conditions, a needle is placed into the peritoneal space and fluid is withdrawn. Paracentesis may be considered as a first step if the ascites fluid accumulates quickly and the abdominal distension causes pain or shortness of breath. Because the peritoneal fluid contains albumin, if large amounts of fluid (more than 5 liters) are withdrawn, an albumin transfusion may be needed.
Paracentesis may be done more than once, but if it becomes a frequent necessity for symptom control, other options may be considered.
The complications of paracentesis include infection, bleeding, electrolyte disturbances, and perforating an organ such as the intestine. However, intense ascites, the benefits outweigh the risks in providing relief to the patient.
Medically Reviewed by a Doctor on 7/28/2015
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