A 48-year-old man with decompensated cirrhosis (Child-Pugh C) develops spontaneous bacterial peritonitis (SBP). Ascitic fluid PMN count is 310 cells/mm³. Serum creatinine is 1.3 mg/dL. Which additional treatment alongside antibiotics has been shown to reduce mortality and prevent hepatorenal syndrome?
- A IV albumin 1.5 g/kg on day 1 and 1 g/kg on day 3 ✓
- B IV furosemide to reduce ascitic volume
- C Terlipressin alone without albumin
- D Oral rifaximin and spontaneous resolution monitoring
Explanation
The landmark Sort et al. (1999) trial in NEJM demonstrated that IV albumin (1.5 g/kg at diagnosis and 1 g/kg on day 3) combined with antibiotics significantly reduced the incidence of hepatorenal syndrome (type 1) and in-hospital mortality in SBP — particularly in patients with serum creatinine > 1 mg/dL, blood urea > 30 mg/dL, or serum bilirubin > 4 mg/dL. This remains the standard of care per EASL and AASLD guidelines. Furosemide would worsen renal perfusion. Terlipressin alone without albumin is not the protocol for SBP. Rifaximin is used for prevention of hepatic encephalopathy.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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