[Treatment of cirrhotic ascites]

The treatment of cirrhotic ascites is based on restriction of dietary sodium and fluid intake coupled with diuretics. Ascitic fluid must always be sampled and infection ruled out. Large abdominal paracenteses are dangerous. Most patients with ascites respond to the dietary-diuretic regimen. The clinician must be watchful for overdiuresis. Some patients need diuretics in ever-increasing doses in an attempt to increase urine flow and are at particular risk of functional renal failure. In these diuretic-resistant cases the ascitic fluid can be withdrawn, ultra-filtered and reinfused by means of suitable apparatus. In 1974, LeVeen and co-workers described a peritoneo-venous shunt system which provides more continuous treatment over many months. The morbidity and mortality of this shunt are difficult to determine from published reports. Long-term controlled studies are needed. The beneficial effect on survival of treatment of cirrhotic ascites is still questioned.