A 55-year-old woman with decompensated alcoholic cirrhosis and tense ascites undergoes large-volume paracentesis with removal of 5 litres of ascitic fluid. According to evidence-based practice, what is the recommended plasma expander to prevent post-paracentesis circulatory dysfunction?
- A 25% albumin at 6-8 g per litre of ascites removed ✓
- B Hydroxyethyl starch at 30 mL/kg
- C Gelatin-based colloid at 500 mL bolus
- D 0.9% normal saline at 150 mL/hour
Correct answer: A. 25% albumin at 6-8 g per litre of ascites removed
Explanation
International Ascites Club and AASLD guidelines recommend 25% albumin at 6-8 g per litre of ascites removed when >5 litres are drained, to prevent post-paracentesis circulatory dysfunction (PPCD). The albumin for paracentesis in cirrhosis ( sort) trial and meta-analyses support this. Hydroxyethyl starch and gelatin are contraindicated in cirrhosis. Saline is inferior to albumin for volume expansion in this setting.
Reference: Schiff's Diseases of the Liver, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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