What is the recommended first-line management of ascites in cirrhosis?

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Multiple Choice

What is the recommended first-line management of ascites in cirrhosis?

Managing ascites in cirrhosis hinges on reducing fluid accumulation while protecting kidney function, using sodium restriction plus diuretic therapy. Spironolactone is used first because cirrhosis drives increased aldosterone, which promotes sodium and water retention; blocking aldosterone directly reduces sodium reabsorption in the distal nephron and helps mobilize fluid. If needed, furosemide is added to enhance diuresis, but the combination is carefully titrated to avoid electrolyte imbalances and renal injury. A typical plan includes a low-sodium diet (about 2 g/day) and gradual uptitration of spironolactone, with modest addition of furosemide to target about 0.5 kg of weight loss per day and monitor potassium and creatinine. Paracentesis becomes important for tense or refractory ascites or when rapid symptom relief is needed, and may be performed with albumin replacement to prevent circulatory dysfunction. Shunts or other invasive measures are reserved for cases not controlled with optimized diuretics and lifestyle measures. Antibiotics or antivirals are not standard initial management for ascites unless there is an infection such as spontaneous bacterial peritonitis.

Managing ascites in cirrhosis hinges on reducing fluid accumulation while protecting kidney function, using sodium restriction plus diuretic therapy. Spironolactone is used first because cirrhosis drives increased aldosterone, which promotes sodium and water retention; blocking aldosterone directly reduces sodium reabsorption in the distal nephron and helps mobilize fluid. If needed, furosemide is added to enhance diuresis, but the combination is carefully titrated to avoid electrolyte imbalances and renal injury. A typical plan includes a low-sodium diet (about 2 g/day) and gradual uptitration of spironolactone, with modest addition of furosemide to target about 0.5 kg of weight loss per day and monitor potassium and creatinine. Paracentesis becomes important for tense or refractory ascites or when rapid symptom relief is needed, and may be performed with albumin replacement to prevent circulatory dysfunction. Shunts or other invasive measures are reserved for cases not controlled with optimized diuretics and lifestyle measures. Antibiotics or antivirals are not standard initial management for ascites unless there is an infection such as spontaneous bacterial peritonitis.

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