Large-Volume Paracentesis Treatment for Refractory Ascites Due to Lack of Response with Maximum Dosses of Diuretics: A Case Report

Introduction: Refractory ascites (RA) refers to ascites that cannot be mobilized or that has an early recurrence that cannot be prevented by medical therapy. [1] We present a case report of 60 years old male diagnosed with liver cirrhosis with refractory ascites treated by Large-Volume Paracentesis (LVP) due to lack of response with maximum dosses of diuretics. Case Report: A 60-years old man has been diagnosed with cirrhosis hepatic from 8 months ago. He has been hospitalized 2 times in the last 2 months with complaint of discomfort of the stomach and hard to breath. Physical examination revealed a blood pressure 110/70 mmHg, pulse of 100x/minute, respiratory rate of 26 times per minutes, body temperature of 36.5oC. Abdominal examination revealed distended and tense abdomen with positive undulation and shifting dullness which consistent with massive ascites. Total serum protein was 6.5g/dL, with albumin levels of 2.3g/dL, globulin level 4.2 g/dL. Because lack of response despite maximum dosses of diuretics therapy, we decided to performed Large-Volume Paracentesis on the 9 th day of hospitalization, and about 5, 000 mL of yellowish fluid was evacuated. Summary: In this case report, we presented a patient who had refractory ascites with underlying disease liver cirrhosis. We perform Large-Volume Paracentesis (LVP) in this patient to reduce volume of ascites due to lack of response with maximum dosses of diuretics. Removing a large amount of ascites in a short period may induce circulatory dysfunction, a condition known as Paracentesis-induced Circulatory Dysfunction (PICD). Hence, administration of albumin during LVP significantly reduces the incidence of PICD.