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



(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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