[Use of diuretics in the treatment of ascites in patients with cirrhosis]

Acta Gastroenterol Belg. 1990 Mar-Apr;53(2):256-60.
[Article in French]

Abstract

The cirrhotic patient with ascites has an increased tubular reabsorption of sodium. Diuretic therapy allows an urinary loss of sodium. The strongest diuretics which inhibit sodium reabsorption in the ascending limb of the loop of Henle (like furosemide) are not the most effective in cirrhotic patients; indeed the increased load of sodium arriving in the distal part of the tubule is reabsorbed because of hyperaldosteronism. Potassium-sparing diuretics, like spironolactone, which act beyond the sites of reabsorption of most of the filtered sodium, are mostly effective when combined with other diuretics which impair sodium reabsorption more proximally. We propose to treat ascites by: 1. Sodium restriction (maximum: 60 mmol per day); 2. Spironolactone 100 to 500 mg per day, combined with furosemide 40 to 200 mg per day if spironolactone does not induce a natriuretic effect.

Publication types

  • English Abstract

MeSH terms

  • Ascites / diet therapy
  • Ascites / drug therapy*
  • Diet, Sodium-Restricted
  • Diuretics / therapeutic use*
  • Drug Therapy, Combination
  • Furosemide / administration & dosage
  • Humans
  • Natriuresis / drug effects
  • Spironolactone / administration & dosage

Substances

  • Diuretics
  • Spironolactone
  • Furosemide