How Much Ascites Fluid Can Be Safely Removed for the Initial Procedure?

Management and Examination of Ascites

Ascites drainage is a routine procedure for treating large amounts of peritoneal effusion. The causes of ascites in humans are diverse, and it is crucial to determine the nature of ascites promptly. Additionally, as many patients undergo ascites drainage for the first time, the volume of ascites drained must be carefully controlled, generally not exceeding 1000 milliliters, to prevent rapid changes in the pleural cavity and potential drops in blood pressure. So, how much ascites can be drained for the first time? What treatment measures can we take? How can we properly conduct ascites examination?

I. How Much Ascites Can Be Drained for the First Time?

The first time ascites is drained, it should not exceed 1000ml. For the second time and subsequent drainages, the volume should not exceed 3000ml each time. Draining large volumes of ascites can lead to rapid changes in the pleural cavity, resulting in redistribution of blood circulation and manifestations such as decreased blood pressure and rapid pulse rate.

II. Treatment Measures for Ascites

1. Limiting Water and Sodium Intake: Patients with ascites, especially those caused by hypoproteinemia, should strictly control their sodium and water intake. A diet high in sugar, protein, vitamins, and low in fat is recommended. A low-salt diet is also suitable for all patients with transudative or exudative ascites, aiming to excrete excess water through the kidneys.

2. Using Diuretics: Diuretics can be used to accelerate water excretion through the kidneys. Generally, potassium-sparing and potassium-excreting diuretics should be used in combination, or diuretics acting on different parts of the kidney should be combined to achieve optimal diuretic effects without causing electrolyte disturbances (especially preventing increases or decreases in serum potassium ions). The type and dosage of diuretics should be individualized based on the patient's condition, the amount of ascites, and the underlying disease.

3. Supplementing Albumin or Accelerating Protein Synthesis: If ascites is caused by low plasma colloidal osmotic pressure due to hypoproteinemia, in addition to a high-protein diet, albumin should be appropriately administered intravenously to increase plasma colloidal osmotic pressure. This will enhance the diuretic effect of diuretics, leading to increased urine output. Recent studies have shown that recombinant human growth hormone (Somatropin) can be used in patients with ascites caused by liver disease-related hypoproteinemia, as it promotes protein synthesis in hepatocytes, increasing serum albumin levels.

III. Methods for Examining Ascites

Laboratory Examinations: Laboratory tests are often crucial for identifying the underlying cause. Liver function impairment and hypoproteinemia can indicate cirrhosis with massive proteinuria. Elevated blood urea nitrogen and creatinine levels suggest renal dysfunction. Immunological tests are also significant for diagnosing liver and kidney diseases. Abdominal paracentesis can determine the nature of ascites and identify its cause.

1. General Examination:

   • Appearance: Transudates are usually pale yellow, thin, and transparent, while exudates can be of different colors or cloudy. Different causes of ascites can present with distinct appearances.
   • Relative Density: Transudates generally have a relative density below 1.018, while exudates have a relative density above 1.018.
   • Clot Formation: Exudates contain fibrinogen and coagulation activators released by tissue cell damage, making them prone to clotting or flocculation.

2. Biochemical Examinations:

   • Qualitative Mucin Test: Transudates are negative, while exudates are positive. Quantitatively, transudates contain less than 0.25g/L mucin, while exudates contain more than 0.25g/L.
   • Pancreatic Ascites Amylase Elevation: May be observed.
   • Bacteriological and