How do you decide when to initiate or restart diuretics in a cirrhotic patient with ascites if they are receiving a therapeutic paracentesis?  

This question has two parts, one with a straightforward answer, the other with a much more nuanced answer, if I understand it correctly. Any patient receiving a therapeutic paracentesis should start/restart diuretics afterwards. Per the 2021 AASLD guidelines, one of the statements reads “LVP ...

If a patient is on diuretics and is otherwise stable (no AKI, sodium is baseline), I don't hold diuretics for therapeutic paracentesis. If they do have an AKI, that needs to be worked up for cause and treated accordingly before resuming their diuretics. Similarly, if they are in hepatic encephalopat...