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

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When do you start diuretics in a cirrhotic patient with ascites if they are receiving a therapeutic paracentesis (assuming no hemodynamic instability, renal dysfunction, or severe electrolyte derangements)?

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2 Answers
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Mednet MemberInvited Expert
Hospital Medicine · UT Health San Antonio
Answered on · Updated on

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 is the ...

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Mednet Member
Mednet MemberInvited Expert
Hospital Medicine · UT Health San Antonio
Answered on · Updated on

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...

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