Curbside Consultation of the Liver: 49 Clinical Questions

Mitchell L. Shiffman, MD

Question 42: I Was Asked To See A Patient With Tense Ascites. How Much Ascites Is Safe To Remove At Any One Time? (continued)

Adil Habib, MD; HoChong S. Gilles, MS, FNP; Leslie M. Gallagher, MS, ANP; Douglas M. Heuman, MD

Therapeutic paracentesis plays a crucial role in managing symptoms and preventing complications of tense ascites. We believe strongly that there is no limit to the volume of fluid that can be removed safely during a paracentesis, provided the procedure is performed properly. The small risk of postparacentesis circulatory dysfunction (PPCD) leading to renal failure is largely eliminated by concurrent administration of albumin and meticulous sterile technique. In our view, the more timid approach of limited paracentesis is associated with a greater risk of complications because of the…