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Article
April 1960

An Effective Treatment of Refractory Ascites in Cirrhosis of the Liver

Author Affiliations
Los Angeles
From the Department of Medicine, University of Southern California School of Medicine, and the John Wesley County Hospital. Assistant Professor of Medicine (Dr. Redeker); Instructor in Medicine (Dr. Kuzma); Associate Professor of Medicine (Dr. Reynolds).
AMA Arch Intern Med. 1960;105(4):594-600. doi:10.1001/archinte.1960.00270160092011
Abstract

One of the commonest complications of cirrhosis of the liver is the formation of ascites. While in some patients the ascites can be easily controlled with sodium restriction and the use of diuretics, in others these measures are ineffective. In this latter instance, rigid restriction of dietary sodium is mandatory if frequent paracenteses are to be avoided. Even with a restricted sodium intake, if the use of diuretics is ineffective in enhancing urinary sodium excretion there is usually a very slow progression in the accumulation of ascitic fluid. These patients, with cirrhosis and ascites resistant to treatment with potent diuretics, present a very difficult therapeutic problem. Such radical measures as a surgical portacaval shunt (1) and bilateral adrenalectomy (2) have been applied in an effort to control the ascites formation in this type of patient.

The organomercurial diuretics are frequently ineffective in promoting a sodium diuresis, and potentiation of their

References
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Welch, C. S.; Attarian, E., and Welch, H. F.:  The Treatment of Ascites by Side to Side Portacaval Shunt ,  Bull. New York Acad. Med. 34:249 ( (April) ) 1958.
2.
Giuseffi, J.; Werk, E. E., Jr.; Larson, P. U.; Schiff, L., and Elliott, D. W.:  Effect of Bilateral Adrenalectomy in a Patient with Massive Ascites and Postnecrotic Cirrhosis ,  New England J. Med. 257:796 ( (Oct.) ) 1957.Crossref
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Neher, R., and Wettstein, A.:  Physicochemical Estimation of Aldosterone in Urine ,  J. Clin. Invest. 35:800 ( (July) ) 1956.Crossref
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Koplowitz, J. M.; Kleeman, C. R.; Maxwell, M. H., and Dowling, J. T.:  Mineralocorticoid-Glucocorticoid Antagonism with Reference to Sodium Excretion ,  Clin. Res. 7:65 ( (Jan.) ) 1959.
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