A 49-year-old man with tense ascites undergoes large-volume paracentesis with removal of 7 litres of ascitic fluid. To prevent paracentesis-induced circulatory dysfunction, what should be given?

• A Furosemide 40 mg intravenously after the procedure
• B Terlipressin 1 mg every 6 hours for 48 hours
• C Albumin 6 to 8 g per litre of fluid removed ✓
• D Normal saline 500 mL per litre removed

Explanation

When more than 5 litres of ascites is removed, albumin at 6 to 8 g per litre aspirated reduces paracentesis-induced circulatory dysfunction, a fall in effective arterial volume that activates renin and predicts hyponatraemia, renal impairment, and mortality. Saline merely replaces sodium and perpetuates ascites, so it is avoided. Diuretics add nothing acutely, and terlipressin is reserved for hepatorenal syndrome or variceal bleeding, not routine post-paracentesis support.

Reference: Sherlock's Diseases of the Liver and Biliary System, 13th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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