[Rational diuretic therapy in patients with liver cirrhosis].
When ascites develops in a patient with liver cirrhosis his probability to survive the following two years amounts to 50%. It is determined essentially by the residual functional capacity of the liver. In 80 to 90% of patients ascites due to portal hypertension can be managed by salt restriction and diuretics. A daily reduction of body weight of 0.5 to 0.75 kg should not be exceeded because prerenal failure may become a threat. Aldosterone-antagonists are more efficient and have fewer side-effects than loop diuretics. The urinary ratio of Na/K may be used to adjust the therapy. They may lower portal hypertension by an additional direct effect on the vasculature. If diuretics are insufficient or when a rapid therapeutic success is needed, paracentesis of 4-6 l is a safe option if intravascular volume is substituted simultaneously with albumin. Only in the few patients whose ascites is intractable by the forementioned measures, alternatives such as peritoneo-, venous or porto-systemic shunts (nowadays mostly by interventional techniques via a transjugular catheter) should be evaluated. The only treatment which not only attacks ascites symptomatically but also corrects the underlying disease is liver transplantation.
Vogt
B
B
Abteilung für Nephrologie/Hypertonie, Inselspital, Bern. bvogt@insel.ch
Reichen
J
J
D000418:Albumins / Q000627:therapeutic use; D001201:Ascites / Q000209:etiology* / Q000628:therapy; D004232:Diuretics / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D019152:Paracentesis; D013449:Sulfonamides
D000418:Albumins; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D013449:Sulfonamides