Ascites, Due to Portal Hypertension
General and supportive measures Medicine treatment Referral ICD-10 code: R18 GENERAL AND SUPPORTIVE MEASURES Restrict sodium intake, 1-2 mmol/kg/24 hours. Restrict fluids if serum sodium < 130 mmol/L. MEDICINE TREATMENT Spironolactone, oral, 1–3 mg/kg as a single daily dose. Can increase dosage slowly to 4-6 mg/kg/day. Continue for as long as needed to control ascites. Monitor serum pota
General and supportive measures
Medicine treatment
Referral
ICD-10 code: R18
GENERAL AND SUPPORTIVE MEASURES
- Restrict sodium intake, 1-2 mmol/kg/24 hours.
- Restrict fluids if serum sodium < 130 mmol/L.
MEDICINE TREATMENT
- Spironolactone, oral, 1–3 mg/kg as a single daily dose. Can increase dosage slowly to 4-6 mg/kg/day.
- Continue for as long as needed to control ascites.
- Monitor serum potassium.
If insufficient response, add:
- Furosemide, oral, 1-3 mg/kg as a single daily dose.
Note:
Spironolactone to furosemide ratio should be 2.5:1.
OR (do not give furosemide and hydrochlorothiazide together)
- Hydrochlorothiazide, oral, 1 mg/kg/dose 12–24 hourly.
- Maximum dose: 25 mg daily.
Therapeutic paracentesis may be performed to relieve the cardiorespiratory and gastrointestinal manifestations of tense ascites. The upper abdomen, surgical scars, the bladder and collateral vessels should be avoided when inserting the paracentesis needle. 50 mL/kg ascites can be tapped over an hour with IV albumin 1 g/kg to prevent circulatory dysfunction.
REFERRAL
- Urgent: Refractory ascites interfering with respiration.
- For determination of the underlying cause of the cirrhosis, portal hypertension and initiation of treatment.
- Cirrhosis, portal hypertension and/or liver failure not responding to adequate therapy.
- Hepatic encephalopathy.
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024
Chapter 2: Alimentary Tract, 2.3 Hepatic Disease, 2.3.3.2 Ascites, Due to Portal Hypertension