A 52-year-old man with hepatitis C cirrhosis and Child-Pugh B (score 8) develops new onset ascites. Paracentesis shows SAAG 1.4 g/dL, total protein 1.8 g/dL, WBC 400/µL (82% neutrophils). He has no fever. What is the diagnosis and first-line treatment?
- A Malignant ascites; cytology requested before treatment
- B Spontaneous bacterial peritonitis (SBP); treat with IV cefotaxime 2 g 8-hourly for 5 days plus albumin 1.5 g/kg on day 1 and 1 g/kg on day 3 ✓
- C Secondary bacterial peritonitis; emergency surgical consultation
- D Tuberculous peritonitis; start anti-tubercular therapy
Correct answer: B. Spontaneous bacterial peritonitis (SBP); treat with IV cefotaxime 2 g 8-hourly for 5 days plus albumin 1.5 g/kg on day 1 and 1 g/kg on day 3
Explanation
An ascitic fluid PMN count ≥ 250 cells/µL (here 328 neutrophils: 82% of 400) confirms spontaneous bacterial peritonitis. IV cefotaxime or a third-generation cephalosporin for 5 days is first-line. Intravenous albumin (1.5 g/kg on day 1; 1 g/kg on day 3) is mandatory in SBP as it reduces renal impairment and mortality (Sort et al., NEJM 1999 trial). Secondary peritonitis is suggested by multi-organism Gram stain, very high glucose, and LDH.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.