Refractory Ascites - Ascites that cannot be mobilized or early recurrence that cannot be prevented Diuretic Resistant: Lack of response to dietary Na restriction and maximal doses of diuretic Diuretic Intractable: Development of diuretic-induced complications Recurrent Ascites: Ascites that recurs at least on 3 occasions within a 12-month period despite dietary sodium restriction and adequate diuretic dosage Early Recurrence: Re-appearance of grade 2 or grade 3 ascites within 4 weeks of initial mobilization Lack of Response: Weight loss of <0.8 kg over 4 days, Urinary sodium < intake Maximum Doses of Diuretics: Spironolactone 400mg/day or amiloride 30mg/day, Furosemide 160mg/day - both for at least 1 week Diuretic-induced complications: • Renal: ↑Cr by > 100% or to >2.0 mg/dL • Na: ↓ by >10 mmol/L or to <125mmol/L • K: <3 mmol/L or >6 mmol/L • Hepatic encephalopathy #Refractory #Ascites #diagnosis #management #algorithm #treatment #hepatology
