Diuretic Therapy in Patients with Cirrhosis
The mechanism of ascites formation in patients with cirrhosis is outlined. Control requires rigid dietary sodium chloride restriction, limitation of fluid intake and diuretics in various doses and combinations.
One hundred and thirty seven patients with cirrhosis and ascites were treated with dietary sodium restriction and various diuretics alone and in combination. Ascites could be controlled in 130 patients. Failures were in those with particularly severe hepato-cellular failure. In mild cases frusemide alone was adequate. In more severe cases of fluid retention the combination of frusemide with amiloride proved satisfactory. Potassium chloride supplements were given as required. Complications of diuretic therapy included hypokalaemia, hyponatraemia, hypochloraemic alkalosis and azotaemia. The incidence of hypochloraemic alkalosis and of precoma was low when amiloride was used with frusemide.
The importance of adjusting the dose and frequency of diuretic administration is stressed. If large doses of potent diuretics are given to patients with cirrhosis renal failure may be precipitated.
KeywordsAlbumin Sodium Chloride Morphine Bicarbonate Mannitol
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