A paracentesis that removes a large volume of ascies fluid from a patient with cirrhosis can trigger a circulatory dysfunction afterwards. A patient who experiencies circulatory dysfunction tends to have a poor outcome.
The volume of removed asciteis fluid required to trigger the syndrome varies but is typically > 5 liters.
Clinical features:
(1) increased arteriolar vasodilation
(2) effective hypovolemia with a decrease in cardiac output and reduction in mean arterial pressure
Laboratory findings:
(1) elevation in serum renin and aldosterone
Complications:
(1) renal impairment with azotemia
(2) dilutional hyponatremia
An infusion of albumin or a plasma expander can prevent or significantly reduce the severity of the circulatory dysfunction.
Differential diagnosis:
(1) sepsis
(2) cardiomyopathy with heart failure
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