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
HOWARD MM, LEEVY CM. Management of Ascites. Arch Intern Med. 1963;112(5):702-707. doi:10.1001/archinte.1963.03860050089009