Young and Wong described criteria for identifying the therapeutic response for a patient with cirrhotic ascites. The authors are from the University of Toronto.
Optimal regimen:
(1) diuretics (furosemide 160 mg/day and spironolactone 400 mg/day)
(2) sodium restriction with a 50 mmol diet (1 mole is 22.989 grams; 50 mmol is 1.15 grams)
Period of therapy before evaluation: 2 weeks
Clinical Findings
Response
weight loss >= 200 g/day and urinary sodium excretion >= 50 mmol/day
adequate
weight loss < 200 g/day and urinary sodium excretion < 50 mmol/day
diuretic resistant
diuretic-related complications prevent use of an adequate dose of diuretics
diuretic intractable
where:
• urinary sodium excretion per day = (24 hour urine volume in liters) * (urine sodium concentration in mmol/L)
• Diuretic-related complications include severe electrolyte abnormalities, hepatic encephalopathy and/or renal dysfunction.
• The differential diagnosis of diuretic resistance includes noncompliance.
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