November 1963

Management of Ascites

Author Affiliations


From the Division of Hepatic Metabolism and Nutrition, Department of Medicine, Seton Hall College of Medicine and the Jersey City Medical Center.

Arch Intern Med. 1963;112(5):702-707. doi:10.1001/archinte.1963.03860050089009

Ascites refractory to medical therapy has been considered an indication for surgical portal decompression in a good-risk patient1 or a grave prognostic sign otherwise.2 Availability of potent diuretics with differing mechanisms of action has greatly reduced the number of patients who cannot be controlled by medical means. Although some patients fail to respond to current medical therapy, neither the frequency nor the mechanism for such failure has been documented. The present investigation was undertaken to ascertain the incidence and cause for refractoriness to popular diuretic regimens and to determine the significance of nonresponsiveness. The study consisted of an evaluation of the influence of thiazide derivatives, spironolactones, and adrenal steroids administered singly or in combination by a predetermined, randomized schedule to patients not responsive to sodium restriction and mercurial diuretics.

Material and Methods  Hospitalized patients with ascites secondary to cirrhosis were studied in the Clinical Research Center or a

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