A 45-year-old man with alcoholic cirrhosis (Child-Pugh C) presents with fever, abdominal pain, and ascites. Diagnostic paracentesis reveals PMN count 350 cells/mm³, ascitic fluid protein 1.8 g/dL, serum albumin 2.1 g/dL (SAAG 1.3 g/dL). What is the diagnosis and immediate empirical treatment?
- A Spontaneous bacterial peritonitis (SBP); IV cefotaxime 2g every 8 hours plus IV albumin (1.5 g/kg day 1, 1 g/kg day 3) ✓
- B Secondary bacterial peritonitis; urgent surgical exploration and broad-spectrum antibiotics
- C Tuberculous peritonitis; anti-tubercular therapy and corticosteroids
- D Chylous ascites; dietary modification and octreotide
Explanation
Spontaneous bacterial peritonitis (SBP) is diagnosed when ascitic PMN count ≥250 cells/mm³ in the appropriate clinical context without an intra-abdominal surgical source. IV cefotaxime (third-generation cephalosporin) is the empirical treatment of choice. Crucially, IV albumin infusion (1.5 g/kg on day 1, 1 g/kg on day 3) significantly reduces hepatorenal syndrome (HRS) development and mortality — the SORT trial demonstrated a 30% absolute risk reduction in HRS and death when albumin was added to antibiotics. SAAG >1.1 g/dL confirms portal hypertension-related ascites.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.