Randomized comparative study of efficacy of furosemide versus spironolactone in nonazotemic cirrhosis with ascites

Pérez-Ayuso, Rosa María; Arroyo, Vicente; Planas, Ramón; Gaya, Joan; Bory, Felipe; Rimola, Antoni; Rivera, Francisca; Rodés, Juan

doi:10.1016/0016-5085(83)90198-1

Cited by 292 publications

(105 citation statements)

References 24 publications

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“…Medical management alone is not always effective at controlling these effusions, although it has sufficed in our patient for the time being. As illustrated by the present case, inclusion of a distal acting aldosterone antagonist in the diuretic regimen is important as cirrhotics with ascites respond very poorly to loop diuretics alone [10]. Therapies for refractory hydrothorax have included repeated thoracentesis, chemical pleurodesis, and peritoneovenous shunts.…”

Section: Discussionmentioning

confidence: 95%

Spontaneous bacterial pleuritis

Brooks

Thiele

1999

Curr Treat Options Gastro

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Section: Discussionmentioning

confidence: 95%

Spontaneous bacterial pleuritis

Brooks

Thiele

1999

Curr Treat Options Gastro

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“…Spironolactone is more effective than furosemide, but has a slower onset of action [20]. Hence dose of spironolactone is increased every 3-5 d. Dual therapy with spironolactone and furosemide causes early mobilization of fluid, shortens hospitalization and maintains normokalemia and is recommended as initial therapy in patients with recurrent ascites [7,21].…”

Section: Diureticsmentioning

confidence: 99%

Ascites in Children

Bavdekar¹,

Thakur²

2016

Indian J Pediatr

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Ascites is an accumulation of serous fluid within the peritoneal cavity. It is the most common complication of liver cirrhosis. In children, hepatic, renal and cardiac disorders are the most common causes. Portal hypertension and sodium and fluid retention are key factors in the pathophysiology of ascites. Peripheral arterial vasodilatation hypothesis is the most accepted mechanism for inappropriate sodium retention and formation of ascites. Diagnostic paracentesis is indicated in children with newly diagnosed ascites and in children with suspected complications of ascites. Ascitic fluid is evaluated for cell count, protein level, and culture. The serum-ascites albumin gradient (SAAG) is the best single test for classifying ascites into portal hypertensive (SAAG >1.1 g/dl) and non-portal hypertensive (SAAG <1.1 g/dl). A neutrophil count ≥250 cells/mm is highly suggestive of bacterial peritonitis. The treatment of ascites due to non-liver disease depends on the underlying condition. In liver disease, diuretics as monotherapy or dual therapy and salt restriction form the mainstay of treatment in children with mild to moderate ascites. Fluid restriction is helpful in children with hyponatremia. In non-responsive ascites or in children with large ascites, large volume paracentesis (LVP) with albumin infusion should be performed. In children with refractory ascites, LVP with albumin administration, transjugular intrahepatic porto-systemic shunt (TIPS), peritoneo-venous shunting and liver transplantation are other therapeutic modalities that need to be considered.

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“…Diuretics are indicated for all patients with grade 2 ascites. Patients with their first episode of ascites usually respond with spironolactone 50-100 mg/day [18,19,[28][29][30]. Patients with recurrent episodes of ascites should receive the combination of spironolactone 100 mg/day with furosemide 40 mg/day.…”

Section: Moderate-volume Ascitesmentioning

confidence: 99%