Compartmentalization of Ascites and Edema in Patients with Hepatic Cirrhosis

Abstract

Compartmentalization of ascites and nonascitic fluid was demonstrated in cirrhotic patients treated with dietary sodium restriction, diuretic therapy or paracentesis. Disparity between ascitic and nonascitic fluid absorption rates, evident during spontaneous diuresis, was exaggerated by diuretic administration. Despite rapid diuresis maximum ascites absorption rate was 930 ml per 24 hours — close to the rate of intraperitoneal saline absorption by noncirrhotic human subjects. After paracentesis ascitic fluid re-formed at as much as three and a half times the maximum absorption rate. It began to form during the paracentesis procedure and continued at a gradually decreasing rate for three to four days. The ascites formed largely by a shift of nonascitic fluid to the peritoneal cavity. However, some patients also formed ascites from retained exogenous fluid; they gained weight, and mild dilutional hyponatremia developed. Compartmentalization of ascites and edema probably causes some complications that follow attempts to remove abnormal extracellular-fluid collections by paracentesis or diuresis.