Combined Ascitic-Fluid and Furosemide Infusion in the Management of Ascites

The effect of ascitic-fluid infusion and furosemide administration alone and in combination was studied acutely in eight patients with massive ascites. Ascitic-fluid infusion alone increased glomerular filtration rate, renal plasma flow and potassium excretion, with no change in urine volume or sodium excretion. Furosemide infusion alone produced no change in glomerular filtration rate or renal plasma flow, but increased urinary volume, sodium and potassium excretion. The effects of combined ascitic-fluid and furosemide infusion were more pronounced, resulting in a rise of 32 to 152 per cent in glomerular filtration rate, and of 33 to 210 per cent in renal plasma flow. This was associated with an increase in urine volume from 0.76 ± 0.4 to 19.2 ± 8.2 ml per minute, in sodium excretion from 8 ± 9 to 1852 ± 876 µEq per minute, and in potassium excretion from 46 ± 23 to 397 ± 148 µEq per minute. Weight loss ranged from 1.8 to 6.8 kg (4 to 15 lb). There was no deterioration in renal function during the week after the infusions. PARACENTESIS and the administration of diuretics in an attempt to reduce the ascites of patients with liver cirrhosis may lead to impaired renal function.^{1 2 3 4} Abdominal paracentesis alone results in reaccumulation of the ascitic fluid from the intravascular space, causing further reduction of the diminished “effective” plasma volume.^{4, 5} This in turn may impair renal perfusion and precipitate renal failure.⁶ Diuretic agents, on the other hand, reduce ascites indirectly. The diuresis that follows their administration shrinks plasma volume and requires the movement of ascitic fluid into the vascular space to restore “effective” plasma volume. Delay or failure of ascitic fluid to move.