Caring for Chronic liver disease: Defining diuretic resistant ascites
End stage liver disease care requires specialist attention for improving survival. When a person develops complications, they must be entered on the transplant waitlist. If circumstances dictate that the wait for a liver from a brain dead donor is delayed, the option for living donor liver transplantation must be actively exercised. For people with no living donor option, one must optimism the liver disease till transplant is performed.
Ascites is one of the complications of end stage liver disease. Ascites is a collection of fluid in the belly. The fluid collection is because of the body's misunderstanding of the amount of blood in your circulation and the misreading of the circumstances leads to retention of salt ( primarily sodium) in your body. We at the Institute, follow a four stage model to assess the particular stage in the ascites management of the individual patient: Pre ascitic, diuretic responsive ascites, diuretic resistant ascites and presence of hepatorenal syndrome.
In this blog post we will provide information as to how we will progress to diagnose whether your ascites is diuretic responsive or resistant. All ascites is presumed to be responsive to diuretics (water pills) and you will be started on diuretics at your initial visit. All our patients are on a combination of diuretics (Lasix and Aldactone) to target different mechanisms to restore normalcy. When the goal for weight loss is not achieved, we always check whether the medications were taken appropriately.
Once we assure that the medications are taken appropriately and the response is poor, we initiate our protocol. The goal is to increase the dose of both the diuretics till maximum doses are reached or complications occur because of diuretics. You will be required to see your hepatologist (Liver specialist) every week till appropriate goal is reached. This will take a minimum of 4 weeks. You will be asked to do the required labs twice weekly and report to the medical team over phone.
Once there is a suspicion of diuretic resistance, you will be admitted for 1 day. The diuretic will be given as an injection and we will check the level of sodium in your urine. If the level of sodium in your urine is low (< 50 mEq every 8 hours), we will initiate the next step to treat the ascites as it will no longer respond to diuretics.
The treatment will be do do large volume paracentesis and expedite the transplant. Cost of care at this point will be approximately 25, 000 rupees per week for the paracentesis and the albumin replacement.
Ascites is one of the complications of end stage liver disease. Ascites is a collection of fluid in the belly. The fluid collection is because of the body's misunderstanding of the amount of blood in your circulation and the misreading of the circumstances leads to retention of salt ( primarily sodium) in your body. We at the Institute, follow a four stage model to assess the particular stage in the ascites management of the individual patient: Pre ascitic, diuretic responsive ascites, diuretic resistant ascites and presence of hepatorenal syndrome.
In this blog post we will provide information as to how we will progress to diagnose whether your ascites is diuretic responsive or resistant. All ascites is presumed to be responsive to diuretics (water pills) and you will be started on diuretics at your initial visit. All our patients are on a combination of diuretics (Lasix and Aldactone) to target different mechanisms to restore normalcy. When the goal for weight loss is not achieved, we always check whether the medications were taken appropriately.
Once we assure that the medications are taken appropriately and the response is poor, we initiate our protocol. The goal is to increase the dose of both the diuretics till maximum doses are reached or complications occur because of diuretics. You will be required to see your hepatologist (Liver specialist) every week till appropriate goal is reached. This will take a minimum of 4 weeks. You will be asked to do the required labs twice weekly and report to the medical team over phone.
Once there is a suspicion of diuretic resistance, you will be admitted for 1 day. The diuretic will be given as an injection and we will check the level of sodium in your urine. If the level of sodium in your urine is low (< 50 mEq every 8 hours), we will initiate the next step to treat the ascites as it will no longer respond to diuretics.
The treatment will be do do large volume paracentesis and expedite the transplant. Cost of care at this point will be approximately 25, 000 rupees per week for the paracentesis and the albumin replacement.
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