CASE On day 4 of hospitalization, the patient was determined to be stable for discharge, with close follow-up. After completion of three days of IV antibiotics on an outpatient basis, the patient began ciprofloxacin (500 mg/d) for SBP prophylaxis. His status on the transplant list was reactivated and, two weeks later, the patient received a liver transplant.
CONCLUSION
As the number of patients living with cirrhosis increases, it is very important for health care providers to appropriately identify and treat this patient population. Ascites and SBP can be deadly but can also be treated effectively. Ideal management includes early identification, proper laboratory testing and radiologic imaging, treatment with fluids and albumin, antibiotic administration in the acute care setting, and antibiotics for SBP prophylaxis. Diuretics should be used with caution and doses adjusted based on clinical judgment and the patient’s presentation. Patients should be referred for liver transplant evaluation. Early identification and treatment of ascites and SBP are essential for patient survival.
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