Managing Complications of Portal Hypertension in Cirrhosis

This clinical practice update summarizes published literature and expert opinion on evaluating and managing ascites, hepatic hydrothorax, volume overload, and hyponatremia in patients with cirrhosis.

Key Recommendations

Volume overload

• All outpatients with volume overload, ascites, or hepatic hydrothorax should restrict dietary sodium (<2000 mg/day), be referred to a dietician, and receive diuretics at the lowest effective dose.

• Inpatients with edema or anasarca should receive intravenous loop diuretics (i.e., furosemide or bumetanide) by bolus or continuous infusion, with careful dose escalation every 2 to 3 days.

• A patient with refractory signs and symptoms might requir…