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 One of the most common complications

of cirrhosis.
 Associated with poor prognosis
 Main treatment for ascites is dietary
sodium restriction and diuretics.
 Large volume paracentesis, greater than
5 Liters, is recommended for ascites that
is not reactive to diuretics.
 Removing a large volume of fluid without
administering a volume expander may
lead to significant hemodynamic
changes.

 This is known as PICD--paracentesis
induced circulatory dysfunction.
 Several studies have been conducted
using various agents in order to prevent
PICD during large volume paracentesis.
 Albumin was found to be the most
effective.
 Albumin is the most abundant protein in
plasma.
 After LVP in patients with ascites without
given volume expansion leads to complex
circulatory abnormalities.
 Complication such as:
› Renal impairment
› Increase in cardiac output and stroke volume
› Severe hyponatremia
› Increased accumulation of ascitic fluid
› Hepatic encephalopathy
› Reduced survival rates
 Albumin is very costly
 Lack of cost/effectiveness ratio clinical
studies.
 Suggested Albumin replacement is 4
Grams per Litre of ascitic fluid removed
 Bernardi M, Ricci C, Zaccherini G. Role of
Human Albumin in the Management of
Complications of Liver Cirrhosis. Journal of
Clinical and Experimental Hepatology 2014;
4(4):302-311.
 Hussain W, Khalid AB, Usmani T, Ghufran A,
Shah H. Low Dose Albumin for the
Prevention of Renal Impairment Following
Large Volume Paracentesis in Cirrhosis. Pak
J Med Sci 2015;31(3):592-596