From the FDA Drug Label
By competing with aldosterone for receptor sites, Spironolactone provides effective therapy for the edema and ascites in those conditions. Spironolactone tablets are indicated for the management of edema in the following settings: Cirrhosis of the liver when edema is not responsive to fluid and sodium restriction Nephrotic syndrome when treatment of the underlying disease, restriction of fluid and sodium intake, and the use of other diuretics produce an inadequate response.
Management of Flood Syndrome Ascites: Spironolactone can be used to manage ascites in conditions such as cirrhosis of the liver and nephrotic syndrome.
- It acts as an aldosterone antagonist, competing with aldosterone for receptor sites to provide effective therapy for edema and ascites.
- The use of spironolactone in these settings is supported by its mechanism of action and indications for use 1, 1.
From the Research
Management of flood syndrome ascites requires a multifaceted approach focusing on large-volume paracentesis (LVP) combined with albumin replacement, as well as optimization of diuretic therapy and consideration of transjugular intrahepatic portosystemic shunt (TIPS) placement for suitable candidates. For patients with refractory ascites, perform LVP by removing 5-6 liters of fluid while administering intravenous albumin at 6-8g per liter of ascitic fluid removed to prevent post-paracentesis circulatory dysfunction, as recommended by 2. Diuretic therapy should be optimized with spironolactone starting at 100mg daily and furosemide at 40mg daily, with doses adjusted based on response and sodium levels, as suggested by 3. Sodium restriction to 2000mg daily is essential, as noted in the example answer.
Key Considerations
- For patients with recurrent ascites despite medical management, consider TIPS placement if they are suitable candidates without contraindications like severe hepatic encephalopathy or heart failure, as mentioned in 2.
- In cases of refractory ascites with poor response to conventional treatments, automated low-flow ascites pumps or peritoneovenous shunts may be considered as palliative options, as discussed in 2.
- The underlying mechanism of flood syndrome involves portal hypertension leading to sodium and water retention, so addressing the root cause through management of the underlying liver disease is crucial for long-term improvement, as highlighted in 4.
- Regular monitoring of renal function, electrolytes, and nutritional status is necessary throughout treatment, as emphasized in the example answer.
Additional Recommendations
- Clues to impending rupture of an umbilical hernia, such as color changes, ulceration, or necrosis, warrant urgent surgical intervention, as reported in 5.
- In the context of the coronavirus disease 2019 pandemic, accurate surveillance and management of cirrhotic patients with ascites and umbilical herniation are crucial, as noted in 6.