A 62yo man has multiple liver mets due to adenocarcinoma with an unknown primary

A 62yo man has multiple liver mets due to adenocarcinoma with an unknown primary. He is

deeply jaundiced and has ascites with edema upto the buttocks. He is now drowsy and his family

are worried that he is not drinking enough. His meds include: haloperidol 1.5mg, lactulose 10ml.

Bloods taken 3d ago: electrolytes normal, urea=6.5mmol/l, creatinine=89mmol/l,

calcium=2.04mmol/l, albumin=17g/L, total bilirubin=189mmol/l. What is the single most

appropriate management of his fluid intake?

a. Albumin infusion

b. Crystalloids IV

c. Crystalloids SC

d. Fluids via NGT

e. Fluids PO

Ans. The key is A. Albumin infusion. [Here serum albumin is 17. So the patient developed ascites and oedema secondary to reduced plasma colloidal osmotic pressure. Albumin infusion can help rise the colloidal osmotic pressure and improve the patients condition].