Cirrhosis With Refractory Ascites: Serial Large Volume Paracentesis, TIPS, or Transplantation?  Vandana Khungar, Sammy Saab  Clinical Gastroenterology and Hepatology  Volume 9, Issue 11, Pages 931-935 (November 2011) DOI: 10.1016/j.cgh.2011.04.028 Copyright © 2011 AGA Institute Terms and Conditions

Figure 1 Suggested approach to the cirrhotic patient with ascites not responsive to diuretics. GI, gastrointestinal; NSAID, nonsteroidal anti-inflammatory drug; OLT, orthotopic liver transplant; SBP, spontaneous bacterial peritonitis. †Lack of response defined as mean weight loss <0.8 kg over 4 days and urinary sodium output less than sodium intake on intensive diuretic therapy (spironolactone 400 mg by mouth daily and furosemide 160 mg by mouth daily) for at least 1 week and on a sodium restricted diet of <90 mmol/L per day or 5.2 g of salt per day. ‡Refractory ascites defined by the International Ascites Club is either: (1) diuretic resistant ascites—ascites that cannot be mobilized or the early recurrence of which cannot be prevented because of a lack of response to dietary sodium restriction and intensive diuretic treatment; or (2) diuretic-intractable ascites—ascites that cannot be mobilized or the early recurrence of which cannot be prevented because of the development of diuretic-induced complications that preclude the use of an effective diuretic dosage. Clinical Gastroenterology and Hepatology 2011 9, 931-935DOI: (10.1016/j.cgh.2011.04.028) Copyright © 2011 AGA Institute Terms and Conditions