Active Ingredients: Norfloxacin
As previously mentioned, patients with ascites grade 2 require diuretic treatment if there is no contraindication. It has been extensively debated whether both types of diuretics should be combined from the beginning or use aldosterone antagonists in a stepwise increase every 7 days with furosemide added only in patients not responding to high doses of aldosterone antagonists.
It can be concluded that a diuretic regime based on the combination of aldosterone antagonists and furosemide is the most adequate approach for patients with recurrent ascites but not for patients with a first episode of ascites.
If there is no response, adherence to a low sodium-diet and diuretic treatment should be confirmed through a good anamnesis and a 24-hour urine sodium excretion measurement.
Given that full-day collections are cumbersome, the measurement of urine creatinine helps determine if the collection of the 24-hour specimen has been complete. Less creatinine is indicative of an incomplete collection.
A sodium concentration that is greater than the potassium concentration correlates well with a 24-hour sodium excretion. The higher the ratio, the greater the urine sodium excretion. Unfortunately, diuretics can also have side effects and cause fluid and electrolytes balance disturbances such as hyponatremia, dehydration, renal impairment, hyperkalemia, or hypokalemia and subsequently, hepatic encephalopathy.
For all these reasons, patients should be closely followed after the onset of diuretic treatment.
Thus, a clinical evaluation and measurements of serum and urine electrolytes must be performed within the first 2 weeks after starting or modifying their dose.
When any of the abovementioned side effects appear, diuretics should be stopped or their dose reduced.After three weeks of trying to get him to have it.
A particular side effect of spironolactone is tender gynecomastia and muscle cramps in some patients.
Amiloride, a diuretic acting in the collecting duct, is less effective than aldosterone antagonists and should be used only in those patients who develop severe side effects with aldosterone antagonists.
Other general measures Treatment of the underlying disease whenever possible is of great importance as dramatic responses have been described after alcohol abstinence, antiviral, and immunosuppressive therapies in patients with alcoholic, viral and autoimmune liver diseases, respectively.
Nutritional therapy can ameliorate nutritional status in cirrhotic patients, reduce infection rates, and decrease perioperative morbidity. Some drugs must be avoided or use with caution in patients with ascites such as NSAID due to the high risk of developing further sodium retention, hyponatremia, and renal failure.
Interestingly, Metamizol use was more common in patients with persistent AKI than in those with transient AKI, and therefore, this drug should also be used with caution. Bed rest was previously recommended on the basis that the upright posture could aggravate the already elevated plasma renin levels of patients with liver cirrhosis and ascites.
However, it is no longer advocated as there is insufficient evidence to support its use as part of ascites treatment.
There is an ongoing debate about the use of nonselective betablockers in patients with refractory ascites. Finally, in unblinded randomized clinical trials RCTs, the long-term albumin infusion 25 gweekly for one year and 25 g every two weeks thereafter improved survival in patients with new onset ascites.