High-Dose Diuretic as Treatment of Refractory Ascites Compared with Paracentesis: An Evidence Based Case Report

Nicholas Wijayanto, I Made Suma Wirawan

Abstract: Introduction Cirrhosis hepatic is severe scarring in liver tissue caused by progression of chronic liver disease. Refractory ascites are seen in 5-10 % in cirrhosis hepatic patients. The treatment of refractory ascites are diuretics and paracentesis. Case illustration 50 years old male with refractory ascites caused by cirrhosis hepatic came to hospital with complaint heavy on breathing. We would like to investigate the efficacy between high-dose diuretics and paracentesis in treatment of our patient. Method We search article in PubMed and Proquest, we found 2 eligible Randomized-Controlled Trial (RCT). We do critical appraisal using Center of Evidence-Based Medicine (CEBM) tool from Oxford University. Result In two trial, the result are high-dose diuretic has more efficacy than paracentesis and there was higher incidence of Hepatic Encephalophaty (HE) and Spontaneous Bacterial Peritonitis (SBP) in paracentesis group. In High-dose diuretic group also show better Child-Pugh Score result. Conclusion High-dose diuretics treatment is better than paracentesis in treatment of refractory ascites caused by cirrhosis hepatic.

Keywords: Diuretic, Paracentesis, Refractory ascites