Typology of cirrhotic ascites and how to treat it

  Patients vary according to their water and sodium tolerance and diuretic response. The ascites of cirrhosis is divided into three types.  Type I: Initial onset of small amount of ascites. With rest, sodium restriction and discontinuation of diuretics, spontaneous diuresis occurs within a few days to 2 weeks and the ascites subsides. Patients with this type have blood sodium >130 mmol/l, urine sodium 90-50 mmol/24h, urine sodium/urine potassium >2 glomerular filtration rate and renal plasma flow are normal. Treatment does not require strict control of water intake, while aldosterone diuretics can accelerate the regression of ascites.  Type II: Mostly moderate amount of ascites, treated as described above and without the occurrence of spontaneous diuresis. Patients with this type have blood sodium >130 mmol/L and urinary sodium 40-50 mmol/24 h. Urinary sodium/urinary potassium1 glomerular filtration rate and renal plasma flow are normal. Most cases are effective with anti-aldosterone diuretics, or combined with sodium-excluding diuretics, and strict water restriction during diuresis is not necessary.  Type III: Most of them are massive ascites lasting for more than 3 months. This is the so-called intractable type of ascites. This type of patients blood sodium.