Rimola et al recommended testing of peritoneal fluid and peripheral blood to detect peritonitis in a patient with cirrhosis and ascites. The authors are from multiple universities in the Europe and the United States.


Testing on peritoneal fluid:

(1) LDH

(2) glucose

(3) total protein

(4) white blood cell count

(5) red blood cell count

(6) smear

(7) Gram stain

(8) culture


If the peritoneal fluid is bloody, then the WBC count is corrected by subtracting 1 leukocyte for every 250 RBCs"


corrected WBC count on the peritoneal fluid per µL =

= (measured WBC count) - ((RBC count) / 250)


Testing on blood:

(1) serum LDH

(2) white blood cell count

(3) blood culture


The blood and peritoneal fluid cultures:

(1) should be performed simultaneously

(2) should both be injected into blood culture bottles at the bedside

(3) should have sufficient volume (with >= 10 mL peritoneal fluid)

(4) should include testing for anaerobic bacteria and fungi


Additional tests on the fluid to consider (see previous sections):

(1) lactate

(2) pH

(3) bilirubin


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