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Management and Complications of Cirrhosis and Ascites

Ascites Workup Algorithm
Ascites Management
Refractory Ascites
Hyponatremia
Spontaneous Bacterial Peritonitis (SBP)
Hepatic Hydrothorax
AKI in
Ascites Ascites Workup ... Algorithm Ascites ... Refractory Ascites Hyponatremia ... Complications #diagnosis ... gastroenterology #hepatology
Causes of Hyponatremia - Differential Diagnosis Algorithm
Syndrome of Inappropriate ADH - Euvolemic; no physiologic stimulus to
Algorithm Syndrome ... Neurologic trauma • Drugs ... • Reduced GFR, AKI ... #Nephrology #Differential ... #Diagnosis #Algorithm
Causes of Hyponatremia - Differential Diagnosis Algorithm
Syndrome of Inappropriate ADH - Euvolemic; no physiologic stimulus to
Algorithm Syndrome ... Neurologic trauma • Drugs ... • Reduced GFR, AKI ... #Nephrology #Differential ... #Diagnosis #Algorithm
Modified Hyponatremia Algorithm
Hypertonic Hyponatremia: Hyperglycemia, Mannitol, Urologic irrigants
Hypotonic Hyponatremia: 
 • ADH ON (UOsm > 100):
Cirrhosis, Nephrotic syndrome ... > 30): SIADH, Medications ... Primary polydipsia, Low ... #Algorithm #diagnosis ... #sodium #nephrology
Hypernatremia - Differential Diagnosis Workup Algorithm

1) Check Urine Osmolality:
 > 600 mOsm/kg - Implies extrarenal mechanism
Differential Diagnosis ... Workup Algorithm ... • Euvolemic (Low ... #Workup #Algorithm ... #nephrology #sodium
Workup of Hypercalcemia - Differential Diagnosis Algorithm
High or Normal PTH:
 • Hyperparathyroidism: Parathyroid adenoma, Parathyroid hyperplasia,
Workup of Hypercalcemia ... Algorithm High ... Immobilization, Drugs ... #Algorithm #Workup ... #nephrology #PTH
Hypernatremia Diagnosis and Workup

Step 1 . Repeat the sodium concentration.
Step 2.  Check plasma osmolality.
NORMAL PLASMA
Hypernatremia Diagnosis ... and Workup Step ... • nephrotic syndrome ... #Diagnosis #Workup ... #Algorithm #Nephrology
Acute Kidney Injury (AKI) - Differential Diagnosis Framework
Pre-Renal:
 • Hypovolemia, Cardiorenal, Distributive Shock, HRS, Hypercalcemia, Renal
Kidney Injury (AKI ... - Differential Diagnosis ... Abdominal Compartment Syndrome ... #nephrology #causes ... #algorithm
Hypocalcemia Workup - Differential Diagnosis Algorithm
 • Low Magnesium, High Magnesium - Functional Hypoparathyroidism
 • High
Hypocalcemia Workup ... AlgorithmLow ... deficiency • Drugs ... metastases, Hungry bone syndrome ... #Algorithm #nephrology
Physiologic Approach to Hypotonic Hyponatremia
The next time you have a case of hypotonic hyponatremia, give the
normal volume-based algorithm ... can be high or low ... Cirrhosis, Nephrotic syndrome ... #differential #diagnosis ... table #sodium #nephrology