Albumin After Paracentesis Help or Hinder By Kristina

Albumin After Paracentesis Help or Hinder? By Kristina Salinas, BSN RN

Ascites � 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.

PICD � 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

Hindrance? � Albumin is very costly � Lack of cost/effectiveness ratio clinical studies.

Conclusion � Suggested Albumin replacement is 4 Grams per Litre of ascitic fluid removed

References 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 �