Treatment of ascites in patients with liver cancer

If liver cancer is not treated in time, the patient will develop ascites. At this time, the following treatment plan should be used:

General treatment methods

Rest in bed and limit water and sodium intake. The daily sodium intake is 250-500mg, and the urine sodium is 10-50mmol/24 hours, which means that the sodium retention is not serious. The daily sodium intake is 500-1000mg, that is, 1200-2400mg of sodium chloride, which is equivalent to a low-salt diet. If obvious diuresis occurs or ascites subsides, the sodium intake can be increased by 1000-2000mg per day. Daily water intake should be limited to 1500ml. If serum sodium is less than 130mmol/L, the daily water intake should be controlled below 1000ml. If serum sodium is less than 125mmol/L, the daily water intake should be reduced to 500-700ml.

Diuretic therapy

Hydrochlorothiazide, 25-100 mg each time, taken every other day or 1-2 times a week; triamterene, 50-100 mg per day, taken after meals. Use spironolactone and furosemide, the ratio of spironolactone and furosemide is 100 mg:40 mg. Start with spironolactone 100 mg/day and furosemide 40 mg/day. Diuresis should reduce weight by no more than 0.5 kg per day to avoid inducing hepatic encephalopathy and hepatorenal syndrome.

Ascites concentrated re-infusion

Refractory ascites, or patients with hypovolemia, hyponatremia, hypoproteinemia, and hepatorenal syndrome should be treated with ascites concentration and reinfusion. Contraindications include infectious ascites, cancerous ascites, and endogenous endotoxin ascites; patients with severe liver damage, severe coagulation disorder, or hepatic encephalopathy. Drain 5000-10000ml of water each time, and add 5-10mg of heparin to every 1000ml of ascites. Concentrate it into 500ml and then reinfuse it intravenously.