Refractory Ascites - Ascites that cannot be mobilized or early recurrence that cannot be prevented

Diuretic Resistant: Lack of response to dietary Na restriction and maximal doses of diuretic

Diuretic Intractable: Development of diuretic-induced complications

Recurrent Ascites: Ascites that recurs at least on 3 occasions within a 12-month period despite dietary sodium restriction and adequate diuretic dosage

Early Recurrence: Re-appearance of grade 2 or grade 3 ascites within 4 weeks of initial mobilization



Lack of Response: Weight loss of <0.8 kg over 4 days, Urinary sodium < intake

Maximum Doses of Diuretics: Spironolactone 400mg/day or amiloride 30mg/day, Furosemide 160mg/day - both for at least 1 week

Diuretic-induced complications: 

 • Renal: ↑Cr by > 100% or to >2.0 mg/dL

 • Na: ↓ by >10 mmol/L or to <125mmol/L

 • K: <3 mmol/L or >6 mmol/L

 • Hepatic encephalopathy



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