Diuresis in the Ascitic Patient: A Randomized Controlled Trial of Three Regimens

Fogel, Michael R.; Sawhney, Vinod K.; Neal, Elizabeth A; Miller, Rupert G.; Knauer, C. Michael; Gregory, Peter B.

doi:10.1097/00004836-198100031-00016

Cited by 106 publications

(49 citation statements)

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“…62 Patients with ascites and leg edema due to cirrhosis should be treated with spironolactone (starting with 50 mg daily) combined with furosemide (starting with 40 mg daily). 63,64 In patients with chronic venous insufficiency, diuretics should be used only after leg elevation and compression stockings have failed. At that point, they should be used sparingly and for brief periods.…”

Section: Summary and Recommendationsmentioning

confidence: 99%

Approach to Leg Edema of Unclear Etiology

Ely¹,

Osheroff²,

Chambliss³

et al. 2006

The Journal of the American Board of Family Medicine

159

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A common challenge for primary care physicians is to determine the cause and find an effective treatment for leg edema of unclear etiology. We were unable to find existing practice guidelines that address this problem in a comprehensive manner. This article provides clinically oriented recommendations for the management of leg edema in adults. We searched on-line resources, textbooks, and MEDLINE (using the MeSH term, "edema") to find clinically relevant articles on leg edema. We then expanded the search by reviewing articles cited in the initial sources. Our goal was to write a brief, focused review that would answer questions about the management of leg edema. We organized the information to make it rapidly accessible to busy clinicians. The most common cause of leg edema in older adults is venous insufficiency. The most common cause in women between menarche and menopause is idiopathic edema, formerly known as "cyclic" edema. A common but under-recognized cause of edema is pulmonary hypertension, which is often associated with sleep apnea. Venous insufficiency is treated with leg elevation, compressive stockings, and sometimes diuretics.

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Section: Summary and Recommendationsmentioning

confidence: 99%

Approach to Leg Edema of Unclear Etiology

Ely¹,

Osheroff²,

Chambliss³

et al. 2006

The Journal of the American Board of Family Medicine

159

View full text Add to dashboard Cite

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“…Several factors, including hormones, are considered to be associated with the process of improvement in the colloidal osmotic pressure and the reduction of the ascites. However, the precise mechanism underlying the decrease in the ascites is complicated and has not yet been fully elucidated (7,9). We previously compared the administration of diuretics alone with the combined administration of KD-294 (recombinant HSA) and diuretics, in order to investigate the association between the predicted parameters for the decrease of ascites and weight loss, which was a surrogate marker for the decrease of ascites in the phase II clinical trial of KD-294.…”

Section: Discussionmentioning

confidence: 99%

Contribution of diuretic therapy with human serum albumin to the management of ascites in patients with advanced liver cirrhosis: A prospective cohort study

Nakamura

Sata

Hiroishi

et al. 2014

Molecular and Clinical Oncology

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Abstract. The number of available studies on the role of human serum albumin (HSA) in the treatment of cirrhotic ascites is currently limited. In this study, we aimed to investigated the parameters associated with diuretic therapy with HSA in patients with advanced cirrhotic ascites. The patient inclusion criteria were cirrhotic ascites and a serum albumin (Alb) concentration of <3.5 g̸dl. A total of 49 patients registered and 38 patients were ultimately included in this study. The enrolled patients were mainly treated with oral spironolactone and furosemide, which were not specified; the HSA amount was also not specified, although the administration period was set to a maximum of 7 days. Our results demonstrated that the administration of HSA significantly increased the serum levels of Alb [0.97 g̸dl; two-sided 95% confidence interval (CI): 0.83-1.11 g̸dl] and decreased body weight (-2.24 kg; 95% CI: -3.06 to -1.43 kg), hematocrit ratio (0.96; 95% CI: 0.94-0.98) and plasma renin concentration (day 4; geometric mean fold change, -0.1528; 95% CI: -0.2510 to -0.0545; log-transformed data) in patients with advanced cirrhotic ascites. The observed weight loss was found to be correlated with the total amount of HSA administered (P=0.0012), as indicated by the results of the multiple linear regression analysis. In conclusion, this study confirmed the efficacy of HSA in patients with advanced cirrhotic ascites.

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“…Am besten hat sich das konventionelle Stufenschema bewährt (Abb. 2): Zunächst sind Bettruhe und Natriumrestriktion angezeigt (2,6,14,23). Eine Beschränkung der täglichen Kochsalzzufuhr auf 3 g (etwa 50 mmol) scheint praktikabel, auch im Hinblick auf die Compliance, und erleichtert das Erzie- Von besonderer Bedeutung für die Durchführung der diuretischen Behandlung ist es, Kontraindikationen zu beachten und die Therapie sorgfältig zu über-wachen; dies um so mehr, als bei dieser nicht kausalen Behandlung Nebenwirkungen unbedingt vermieden werden sollten.…”

Section: Sideris-okkluderunclassified