Fluid overload

The ascites associated with liver failure is secondary to portal hypertension (seen in cirrhosis, hepatocellular cancer and extensive hepatic metastases).

The ascitic fluid has a relatively low albumin concentration, a difference of >11g/L between serum and ascitic fluid. This often responds well to a median daily dose of 200-300mg spironolactone, with up to 90% of cirrhotic patients noticing a benefit.

If a patient fails to respond to or tolerate diuretic treatment, paracentesis can be considered. If a patient requires frequent paracentesis, a tunnelled drain can be considered, depending on the prognosis. Contact your local service for further advice.


This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.

Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.

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