A 48-year-old man with alcoholic cirrhosis (Child-Pugh B) is admitted with large volume ascites. Abdominal paracentesis drains 5.5 litres. Serum albumin is 2.8 g/dL. Which intervention prevents post-paracentesis circulatory dysfunction (PPCD) most effectively?

• A IV normal saline 500 mL per litre removed
• B Terlipressin 1 mg IV every 6 hours for 3 days
• C Midodrine orally starting 2 hours before paracentesis
• D IV albumin 8 g per litre of ascites removed ✓

Explanation

Post-paracentesis circulatory dysfunction (PPCD) occurs after large volume paracentesis (>5 L) due to effective hypovolaemia from peripheral vasodilation. IV albumin (8 g/L of ascites removed) is the most evidence-based intervention to prevent PPCD and reduces 3-month mortality; this is the recommendation of EASL and AASLD guidelines. Saline and synthetic colloids are inferior to albumin. Terlipressin is used for hepatorenal syndrome, not PPCD prevention during paracentesis.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.