title: High Dose Oral Furosemide with Salt Ingestion in the Treatment of Refractory Ascites of Liver Cirrhosis.
abstract: We aimed to evaluate and compare the efficacy and safety of high-dose furosemide+salt orally by comparing HSS+ furosemide (i.v.) and repeated paracentesis in patients with RA.
  
  
  
  This was a prospective study of 78 cirrhotic patients with RA, randomized into three groups: Group A (n= 25) i.v. furosemide (200-300 mg bid) and 3% hypotonic saline solution (HSS) (once or twice a day); Group B (n= 26) oral furosemide tablets (360-520 mg bid) and salt (2.5 g bid); and, Group C (n= 27) repeated large-volume-paracentesis (RLVP) with albumin infusion. Patients without hyperkalemia were administrated 100 mg of spironolactone/day. During the follow-up; INR, creatinine, and total bilirubin levels were measured to determine the change in MELD (model of end stage liver disease) score.
  
  
  
  Hepatic encephalopathy (HE), severe episodes of spontaneous bacterial peritonitis (SBP) and pleural effusions (PE) occurred more frequently in Group C. Improvement in Child-Pugh and MELD score was better in Group A and B than Group C. In Group B, improvements were seen in the Child-Pugh and MELD score, reduction in body weight, duration and number of hospitalization. In Groups A and B, remarkable increases in diuresis were observed (706±116 to 2425±633 mL and 691±111 to 2405±772 mL) and serum sodium levels also improved. HE and SBP were occurred more often in group C (p<0.002). Hospitalization decreased significantly in Group B (p<0.001). There was no significant difference in survival among groups.
  
  
  
  High dose oral furosemide with salt ingestion may be an alternative, effective, safe and well-tolerated method of therapy for RA.
authors.affiliation: . drtolakar@hotmail.com.
authors.forename: Tolga
authors.initials: T
authors.lastname: Yakar
authors.forename: Mehmet
authors.initials: M
authors.lastname: Demir
authors.forename: Ozlem
authors.initials: O
authors.lastname: Dogan
authors.forename: Alper
authors.initials: A
authors.lastname: Parlakgumus
authors.forename: Birol
authors.initials: B
authors.lastname: Ozer
authors.forename: Ender
authors.initials: E
authors.lastname: Serin
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000737:chemistry; D001201:Ascites / Q000188:drug therapy*; D001663:Bilirubin / Q000032:analysis; D003404:Creatinine / Q000097:blood; D058625:End Stage Liver Disease / Q000188:drug therapy; D005260:Female; D005665:Furosemide / Q000008:administration & dosage*; D006501:Hepatic Encephalopathy / Q000139:chemically induced; D006760:Hospitalization; D006801:Humans; D006947:Hyperkalemia / Q000150:complications; D019934:International Normalized Ratio; D008103:Liver Cirrhosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D019152:Paracentesis; D010538:Peritonitis / Q000139:chemically induced / Q000382:microbiology; D010996:Pleural Effusion / Q000139:chemically induced; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage*; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage; D013148:Spironolactone / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D049994:Sodium Potassium Chloride Symporter Inhibitors; D013148:Spironolactone; D012965:Sodium Chloride; D005665:Furosemide; D003404:Creatinine; D001663:Bilirubin