Large-volume paracentesis in treatment of ascites

Article Abstract:

Ascites is the abnormal accumulation of protein-containing liquid in the abdomen, and can be caused by chronic degenerative diseases of the liver, such as cirrhosis. Prior to the 1950s, ascites was treated by paracentesis, which is a procedure where fluid is withdrawn through a needle that has been placed in the abdomen. Clinical evidence has shown that this procedure caused liver and kidney failure, inflammation of the brain, and a decrease in blood pressure, as well as excessive amounts of urea and decreased levels of sodium in the blood. The standard care for ascites up to the early 1980s included the use of diuretics, which promote sodium and water excretion, bed rest and dietary sodium restriction. Another therapy for ascites involves the use of peritoneovenous shunts, which drain the fluid from the abdomen into the veins. This therapy also carries risks including infection, the formation of blood clots, and the accumulation of fluid in the lung. One study reported that 14 of 23 patients had major complications and 50 percent of deaths could be directly related to the shunts. The death rate from the use of shunts has been estimated to be 25 percent at one month after creation of shunts. A comparative study between diuretic therapy and shunt therapy showed there was no difference in death rates after six months or long-term survival. Recently, the use of paracentesis with an infusion of the protein albumin has been reinvestigated. One study reported that after five liters had been drained from the abdomen, no changes in blood volume, blood pressure or blood concentrations of sodium or urea occurred. Another study reported that ascites disappeared in three to four days with paracentesis, while diuretic therapy took fifteen days. The overall success rate in treating ascites has been reported to be about 95 percent for paracentesis and 73 percent for diuretic therapy. This study reported higher complication rates and longer hospital stays with diuretic therapy than with paracentesis. Thus, paracentesis with albumin infusion seems to be as effective as diuretics in the treatment of ascites, as long as careful monitoring of kidney and liver function is performed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Alternative medicine, Ascites, Paracentesis, Liver cirrhosis, editorial

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Increased osmolal gap in alcoholic ketoacidosis and lactic acidosis

Article Abstract:

Osmolality is a measure of the number of solute particles dissolved in a solution. In the clinical setting, the measurement of the osmolal gap (that which is measured minus that which is calculated) is used to assess the patient's serum water volume and to screen for the presence of certain alcohols. After the ingestion of ethanol, methanol, isopropanol, or ethylene glycol patients have demonstrable osmolal gaps. The need for hemodialysis or other therapies to correct toxic alcohol ingestion is frequently based on the degree of the osmolal gap. A study was designed to determine if an osmolal gap occurs only with toxic alcohol ingestion or of it is also present in other clinical settings. Alcohol ingestion results in an acidosis, a state of less than normal body pH (less than 7.40), or (after the body's compensation) a relatively normal pH with an excess of anions (negatively charged molecules). Twenty-three patients with lactic acidosis caused by seizures, hypotension (low blood pressure), or resuscitation after cardiac arrest were compared with 19 patients with alcoholic ketoacidosis, and with 10 non-acidotic controls. An elevated osmolal gap was found in patients with lactic acidosis and patients with alcoholic ketoacidosis; no significant difference between the two groups was found. Thus, a decision to institute hemodialysis to correct a presumed toxic alcohol ingestion should not be based solely on the measurement of an increased osmolal gap, as the latter is not specific for a alcohol-induced acidosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Measurement, Fluid-electrolyte balance, Alcohol, Ethanol, Acidosis, Osmoregulation, Ketoacidosis, Diabetic ketoacidosis

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Antibiotic-induced D-lactic acidosis

Article Abstract:

Caution should be used when prescribing antibiotics to patients who have had small intestinal bypass surgery. Routine stool cultures in these cases may be advisable in order to customize a course of treatment. D-Lactic acidosis developed on three separate occasions in a patient who received oral antibiotics for routine bacterial infections. Bypass surgery on this patient's small intestine was performed 18 years prior to these symptoms appearing. Symptoms included a loss of muscle coordination, diarrhea, weakness, stuttering and slurred speech. On each occasion, this patient's blood pH was in the acid range. An organism present in the bowel was resistant to all of the antibiotics given and produced lactate when tested. Symptoms disappeared when the antibiotics were discontinued.

Antibiotics, Lactic acidosis

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