A 45-year-old man with alcoholic cirrhosis presents with tense ascites and is not responding to spironolactone 400 mg and furosemide 160 mg. Serum creatinine is 0.9 mg/dL, sodium 128 mEq/L. He undergoes large-volume paracentesis (LVP) of 7 liters. Which agent should be given post-LVP to prevent circulatory dysfunction?
- A Normal saline 1L/L of ascites removed
- B Human albumin 8 g/L of ascites removed ✓
- C Dextran-70 8 g/L of ascites removed
- D Gelatin 4% solution 500 mL
Explanation
Post-paracentesis circulatory dysfunction (PPCD) occurs when >5 liters of ascites are removed, causing splanchnic vasodilation and reduced effective arterial blood volume, precipitating HRS type 1 or sodium/creatinine deterioration. Human albumin infusion at 8 g per liter of ascites removed (starting at >5 L drainage) is the only intervention proven to prevent PPCD and improve survival in RCTs. Artificial colloids (dextrans, gelatins) are less effective and not guideline-recommended for this specific indication. Crystalloids (normal saline) are ineffective as plasma expanders in this context.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.