A 55-year-old man with alcoholic cirrhosis presents with acute tense ascites. He is treated with large-volume paracentesis (5 litres). Which intervention MUST accompany this procedure to prevent post-paracentesis circulatory dysfunction?
- A IV albumin 8 g per litre of ascites removed ✓
- B IV normal saline bolus 1 L
- C IV colloid gelatin or dextran solution
- D No replacement is needed for volumes < 7 litres
Correct answer: A. IV albumin 8 g per litre of ascites removed
Explanation
Post-paracentesis circulatory dysfunction (PPCD) occurs when >5 litres are removed and leads to renin-angiotensin activation, hyponatraemia, and increased mortality. Human albumin infusion at 8 g per litre of ascites removed >5 litres has been shown in multiple RCTs (including the Ginès et al. landmark study) to prevent PPCD significantly better than dextran or gelatin. Normal saline or synthetic colloids are less effective. The threshold for albumin is removal of >5 litres; all European and US guidelines recommend albumin as the preferred plasma expander.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.