Physiologic considerations in the medical management of ascites

Therapy of ascites is important due to the significant morbidity and mortality to which this condition predisposes the cirrhotic patient. After briefly reviewing the pathogenesis of ascites to highlight the central role of sodium retention, the normal and altered physiology of salt and water balance are reviewed to provide a background for formulating a physiologic approach to medical management. Finally, a medical regimen for the management of ascites is suggested, one that employs salt and water restriction and a rational progressive program of diuretics to reverse the pathological sodium retention. Using such an approach, a high frequency of success with minimal complications can be achieved.