Ascites treatment differs according to the underlying disease. In cases such as liver cirrhosis, heart failure and kidney failure, improvement can be achieved by limiting salt and fluid intake in the diet and using diuretic drugs when necessary. Salt restriction is done by reducing the daily salt intake to 2 g. In a normal daily diet, 4g of salt per day is taken by eating normal bread by making the food completely salt-free.
If the bread is also unsalted, this amount decreases to about 2g. For this reason, both the food and the bread should be salt-free in the diet to be applied in acid treatment. Whether the patient adheres to a salt-free diet can be understood by measuring the amount of sodium excreted in the urine.
In some cases, a little more salt intake may be allowed, but this will be decided by the doctor monitoring the patient. In patients who cannot be adequately treated with salt restriction and bed rest, diuretic drugs are added to the treatment (Diuretics). The two most commonly used drugs for this purpose are ‘sprinolactone’ and ‘furosemide’. These two drugs can be used together when necessary.
The daily dose is 40-160mg in furosemide and 100-400mg in spironlactone. In patients with heart and kidney failure, the use of additional drugs and hemodialysis may be required.
Your doctor, who will evaluate your laboratory results and clinical findings, will decide which type of drug will be used in which dose. Diuretic drugs should be given in the morning to prevent the patient from waking up frequently during the night. The use of drugs in high doses can disrupt the fluid and electrolyte balance in the body, causing sometimes life-threatening changes in sodium, potassium, urea and creatinine levels. Patients with liver cirrhosis may experience impaired brain function (Hepatic encephalopathy).
For this reason, patients under diuretic therapy should be evaluated at regular intervals and such undesirable changes should be monitored. When an infection is detected in the ascitic fluid, the patient is treated with appropriate antibiotics. This condition is not uncommon in patients with ascites accompanying liver cirrhosis and is termed ‘spontaneous bacterial peritonitis’. The presence of infection in ascites reduces the response to diuretic therapy and can lead to renal failure, hepatic encephalopathy and septic shock if left untreated. It usually does not respond well to acid diuretic therapy due to infection and cancer.
The response to diet and diuretic therapy can be understood by measuring body weight. In an effective diuretic treatment, patients with ascites should lose at least 0.5 kg per day. In patients with edema in their legs with ascites, this loss should be 1 kg per day. Before changing treatment in treatment-resistant ascites, the patient’s compliance with treatment (salt-free diet and drug use) and whether there is an infection in ascites should be checked.
If a weight loss of 1 kg or more is not achieved within a week despite effective drug treatment, it is referred to as ‘treatment-resistant acid’. This is seen in approximately 15% of patients with liver cirrhosis and is an important finding that shortens life expectancy. In such cases, the patient is relieved by emptying 5-10L of acid at a time with paracentesis [Therapeutic (therapeutic) paracentesis, large volume paracentesis].
Especially in cancer-related ascites, this method is more effective than diuretic therapy and sometimes it may need to be done once a week. Since large volume paracentesis can cause low blood pressure, extreme fatigue, kidney failure and electrolyte disturbance in patients with cirrhosis, it should be performed in experienced clinics and under the supervision of a doctor.