Q: 54 year old male with end stage liver disease may require large volume paracentesis. Patient is labeled as allergic to Albumin. What is your alternative to prevent circulatory dysfunction after large-volume paracentesis?
Answer: Use of terlipressin
The removal of 5 litres of fluid or more is considered large-volume paracentesis. The AASLD (American Association for the Study of Liver Diseases) suggests that postparacentesis albumin infusion may not be necessary for a single paracentesis of less than 5 litres; however, for large-volume paracenteses consider an albumin infusion of 8-10 g per liter of fluid removed.
Another alternative is to use terlipressin (1 mg every 4 hours for 48 hours) rather than albumin for prevention of circulatory dysfunction after large-volume paracentesis. Studies suggest that terlipressin is as effective as albumin.
References: Click to get abstract
1. The efficacy of terlipressin in comparison with albumin in the prevention of circulatory changes after the paracentesis of tense ascites --a randomized multicentric study. Hepatogastroenterology. Oct-Nov 2007;54(79):1930-3.
2. Terlipressin versus albumin in paracentesis-induced circulatory dysfunction in cirrhosis: a randomized study. J Gastroenterol Hepatol. Jan 2006;21(1 pt 2):303-7.