Teaser: 50 y/o F s/p paracentesis


#1

54 year old female with past medical history of HTN, HLD, severe ETOH abuse, esophagitis is admitted for decompensated cirrhosis. She is afebrile with no leukocytosis. Physical exam shows fluid thrill, paracentesis is done with 5L removed. SAAG is >1.1 and there are no fevers or leukocytosis noted. To prevent post procedure hypotension you:

???

  • A) Start patient on NS 150 ml/hr
  • B) Gentle hydration, NS 75 ml/hr
  • D) Albumin 5% 25g TID
  • E) Albumin 25% 40g once

For large volume paracentesis (>5L), albumin 25% 8g per L is recommended to prevent post procedural hypotension!