Strategies in the treatment of ascites

Abnormalities of sodium excretion in chronic liver disease show wide variation. Depending on the degree of decompensation, sodium restriction and diuretic treatment using spironolactone as a basis, paracentesis with substitution of albumin or plasma expanders, or the peritoneovenous shunt is appropriate treatment. Prognostic factors for treatment success are needed. Up to now fractional sodium excretion has been used. Since treatment is palliative, side effects and complications should be minimized. Stepwise treatment and prevention of complications based on an understanding of the pathophysiology are mandatory.