From the Guidelines
Patients with ascites should follow a low-sodium diet of less than 5 g/day, as recommended by the most recent guidelines 1. This dietary approach is essential because sodium retention contributes significantly to fluid accumulation in the abdomen. The key aspects of managing ascites include:
- Sodium restriction: limiting salt intake to less than 5 g/day, which is equivalent to one teaspoon of salt, as suggested by 1 and 1.
- Diuretic therapy: typically starting with spironolactone at 100 mg daily and furosemide at 40 mg daily, with doses adjusted based on response, as outlined in 1.
- Monitoring: regular weight monitoring to assess fluid status and treatment effectiveness, and adjusting diuretic doses accordingly.
- Protein intake: maintaining protein intake at 1.2-1.5 g/kg/day unless hepatic encephalopathy is present.
- Avoiding high-sodium foods and alcohol, which can worsen liver disease and ascites. The most recent and highest quality study, 1, provides the basis for these recommendations, emphasizing the importance of sodium restriction and diuretic therapy in managing ascites. Additionally, 1 supports the use of spironolactone and furosemide as first-line diuretics, with a focus on monitoring and adjusting treatment to achieve optimal outcomes. By prioritizing these evidence-based recommendations, patients with ascites can effectively manage their condition and improve their quality of life.
From the Research
Diet Recommendations for Patients with Ascites
- The recommended diet for patients with ascites involves restricting sodium intake to 2 grams per day 2.
- Restricting sodium intake and enhancing sodium excretion is the mainstay of treatment for ascites, as sodium and water retention is the basic abnormality leading to ascites formation 2.
- A low-sodium diet is a crucial component of the management of ascites, and it should be combined with diuretic therapy 3, 4, 5, 6.
Importance of Dietary Restrictions
- Dietary sodium restriction is essential for the treatment of ascites, and it should be implemented in conjunction with diuretic therapy 2, 3, 4, 5, 6.
- Patients with cirrhosis and ascites must limit their sodium intake to 2 grams per day, and enhancement of sodium excretion can be accomplished by using oral diuretics such as spironolactone and furosemide 2.
Treatment Options for Refractory Ascites
- Refractory ascites is defined as fluid overload that is unresponsive to sodium-restricted diet and high-dose diuretic treatment, and it has a poor prognosis 2, 3, 4, 5, 6.
- Treatment options for patients with refractory ascites include serial therapeutic paracentesis, transjugular intrahepatic portosystemic shunt (TIPS), peritoneovenous shunt, and liver transplantation 2, 3, 4, 5, 6.