General measures

• Identify and if possible eliminate the cause (e.g. drugs, viral hepatitis, septicaemia, toxins, alcohol or upper G.I bleeding)

• Avoid use of all unnecessary drugs including diuretics and sedatives.

• Provide non-protein containing high calorie food (2000 kCal/day)

Drug treatment

Doxycycline (O) 100 mg twice daily through nasogastric tube;

Or

Neomycin (O) 1 g every six hours. Treatment should continue until patient recovers.

Give laxatives to provoke diarrhoea

Magnesium trisilicate (O) 40 ml every six hours.

Or

Magnesium sulphate (O) 4 g with water twice daily, until diarrhoea is induced.

Carry out high bowel washout once.

• Give dextrose 10% (IV infusion) 3 litres/day with 2 g (26 mmol) potassium chloride added to every litre bag (if renal function is satisfactory)

• Check for any infection and treat immediately

• If signs of bleeding are present give Vitamin K (IV) 10 mg

Add

Fresh frozen plasma initially

Add

platelets if count <20 x 10 g/l and patient is still bleeding.

• If ethanol etiology is suspected give

Thiamine (IV) 10 mg before dextrose infusion and continue daily for 3 days.

Ascites of Chronic Liver Failure

• Parecentesis diagnostic should be performed where possible.

• Restrict intake of salt

• Not more than 1 litre of fluid per day

• Weight loss should be at 0.5 kg per day. Further reduction of weight per day could lead to hypovolaemia and induce liver failure.

For patients not responding to the above measures, give

Spironolactone (O) 100 mg once daily, increasing to 400 mg daily as required.

In case the above measures fails

Frusemide (O) start at 40 mg daily increasing gradually.

• Perform large volume paracentesis for massive intractable ascites.

Give: Albumin (IV) 20 gm for every 5 litres drained.