# Ascites - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Ascites - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470482/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DS51.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Egyptian National Drug Formulary - Cardiovascular - Ascites - disease-level clinical article (ascites-clinical.txt) - Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph, edema of hepatic cirrhosis / ascites) - Ascites - disease-level clinical article (ascites-full.txt) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) - Spironolactone — 100 mg — oral.solid - Furosemide — 40 mg — oral.solid ## Complete treatment card ```text ASCITES Sources: Ascites - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470482/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DS51.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Egyptian National Drug Formulary - Cardiovascular, Ascites - disease-level clinical article (ascites-clinical.txt), Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph, edema of hepatic cirrhosis / ascites), Ascites - disease-level clinical article (ascites-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Progressive abdominal swelling, sometimes painless, sometimes with discomfort [abdominal distension] - Weight gain, early fullness with meals, and breathlessness from the fluid buildup [breathlessness · weight gain] - Fever, belly tenderness and confusion point toward spontaneous bacterial peritonitis [abdominal tenderness · confusion · fever] - Unintentional weight loss suggests a malignant cause of the fluid [weight loss] - Breathlessness lying flat, orthopnea and leg swelling point to a cardiac cause [breathlessness · leg swelling · orthopnoea] - Diarrhea, fatty stools, malnutrition and night sweats suggest chylous ascites [ascites · diarrhoea · night sweats · steatorrhoea] SIGNS - what you find (4) - Flank dullness that shifts with position, plus a fluid wave on abdominal exam - Cirrhosis stigmata: spider angiomas, palmar erythema, muscle wasting and jaundice [cirrhosis · jaundice · muscle wasting · redness] - Raised neck veins and lung congestion point to heart failure as the cause [raised JVP] - An umbilical nodule (Sister Mary Joseph nodule) signals a GI, pancreatic or genitourinary cancer [umbilical lump] TESTS (8) - Diagnostic paracentesis with fluid analysis is the fastest way to find the cause - An ascitic fluid neutrophil count of 250 per mm3 or higher diagnoses spontaneous bacterial peritonitis - Serum-ascites albumin gradient predicts portal hypertension with about 97% accuracy - SAAG at or above 1.1 g/dL points to portal hypertension causes like cirrhosis or heart failure - SAAG below 1.1 g/dL points to non-portal-hypertensive causes such as peritoneal cancer or nephrotic syndrome - Serum amylase over 1000 U/L, or more than triple normal, supports a pancreatic cause - Ascitic fluid triglycerides above 200 mg/dL confirm chylous ascites - Ultrasound is the most sensitive imaging test for finding ascites IF NOT THIS - what else fits (11) - Cirrhosis with chronic liver failure - MASH, an advanced fatty-liver disease with fibrosis - Viral hepatitis, types B through E - Disease of the bile ducts or gallbladder - Hepatic vein thrombosis, ie Budd-Chiari syndrome - A dilated, poorly contracting heart muscle - Hepatorenal syndrome as an underlying cause - Pancreatitis causing pancreatic ascites - Protein loss through a diseased bowel - Familial Mediterranean Fever as a cause - Pregnancy complicated by preeclampsia or HELLP syndrome Source StatPearls "Ascites" - disease-level clinical article Status traced to the source above Rx: Main treatment | Loop diuretic - paired with spironolactone for cirrhotic ascites MAIN TREATMENT - choose one 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult Fluid accumulation in the abdominal cavity, most often from cirrhosis in Egypt given the country's high hepatitis-C and chronic liver disease burden; a GP can start diuretics for a known cirrhotic cause but should refer new-onset or complicated ascites for work- up of the underlying cause. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Fluid accumulation in the abdominal cavity, most often from cirrhosis in Egypt given the country's high hepatitis-C and chronic liver disease burden; a GP can start diuretics for a known cirrhotic cause but should refer new-onset or complicated ascites for work- up of the underlying cause. Caution No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - Fever, abdominal tenderness, and confusion in a patient with ascites can signal spontaneous bacterial peritonitis and need urgent evaluation. RED FLAG - Patients with ascites (usually from liver disease) should avoid hepatotoxic medications and OTC drugs that can worsen liver injury - NSAIDs in particular, since they are what a GP might otherwise reach for. RED FLAG - Anyone started on diuretics for ascites needs monitoring of weight, electrolytes, renal function (BUN/creatinine), and urinary sodium. RED FLAG - New-onset ascites without a known cause needs investigation, and signs of hepatic encephalopathy or gastrointestinal bleeding need urgent hospital referral. 2. SPIRONOLACTONE [1st line] Adult Initial: 100 mg once daily; adjust every 3 to 5 days based on response. Maximum dose: 400 mg once daily. Peds 1-3 mg/kg/day [child max 400 mg] (Children (edema/diuresis): Initial 1 to 3 mg/kg/day divided every 6 to 24 hours; titrate as needed; maximum 4 to 6 mg/kg/day in divided doses every 6 to 12 hours or 400 mg/day, whichever is less.) 3kg -> 3-9 mg/day 4kg -> 4-12 mg/day 5kg -> 5-15 mg/day 6kg -> 6-18 mg/day 7kg -> 7-21 mg/day 8kg -> 8-24 mg/day 9kg -> 9-27 mg/day 10kg -> 10-30 mg/day 11kg -> 11-33 mg/day 12kg -> 12-36 mg/day 13kg -> 13-39 mg/day 14kg -> 14-42 mg/day 15kg -> 15-45 mg/day 16kg -> 16-48 mg/day 17kg -> 17-51 mg/day 18kg -> 18-54 mg/day 19kg -> 19-57 mg/day 20kg -> 20-60 mg/day 21kg -> 21-63 mg/day 22kg -> 22-66 mg/day 23kg -> 23-69 mg/day 24kg -> 24-72 mg/day 25kg -> 25-75 mg/day 26kg -> 26-78 mg/day 27kg -> 27-81 mg/day 28kg -> 28-84 mg/day 29kg -> 29-87 mg/day 30kg -> 30-90 mg/day 31kg -> 31-93 mg/day 32kg -> 32-96 mg/day 33kg -> 33-99 mg/day 34kg -> 34-102 mg/day 35kg -> 35-105 mg/day 36kg -> 36-108 mg/day 37kg -> 37-111 mg/day 38kg -> 38-114 mg/day 39kg -> 39-117 mg/day 40kg -> 40-120 mg/day 41kg -> 41-123 mg/day 42kg -> 42-126 mg/day 43kg -> 43-129 mg/day 44kg -> 44-132 mg/day 45kg -> 45-135 mg/day 46kg -> 46-138 mg/day 47kg -> 47-141 mg/day 48kg -> 48-144 mg/day 49kg -> 49-147 mg/day 50kg -> 50-150 mg/day Source Egyptian National Drug Formulary - Cardiovascular Why First-line aldosterone antagonist diuretic for managing fluid accumulation in cirrhotic ascites. Caution Hyperkalemia. Use with caution in hepatic impairment; minor alterations of fluid and electrolyte balance may precipitate hepatic coma. Any renal disease associated with severe renal impairment (CrCl less than 10 mL/minute) or acute renal failure Egypt EPILACTONE 100 MG 10 TABS. EIPICO 7.00 EGP (0.70/unit) SPIRONOLACTONE (DELTA) 100MG 20 TAB. GLOBAL NAPI PHARMACEUTI... 16.80 EGP (0.84/unit) POTASAVE 100 MG 20 TAB ALFACURE PHAR... 21.00 EGP (1.05/unit) ALDACTONE 100MG 20 TAB KAHIRA > SEAR... 22.00 EGP (1.10/unit) POTASPIRONO 100 MG 20 TAB. UNIPHARMA 90.00 EGP (4.50/unit) SPECTONE 100 MG 20 TABS. KAHIRA 90.00 EGP (4.50/unit) LOOP DIURETIC - PAIRED WITH SPIRONOLACTONE FOR CIRRHOTIC ASCITES 3. FUROSEMIDE [1st line] Adult 20 to 50 mg orally once daily, then titrated to effect. The disease article's cirrhotic- ascites pairing is spironolactone 100 mg with furosemide 40 mg, both once daily, keeping the 100:40 ratio when titrating Peds The ENDF's cirrhotic-ascites dosing is stated for adults; no paediatric figure is given for this indication. Source Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph, edema of hepatic cirrhosis / ascites) Why The disease article's first-line regimen for high-SAAG ascites is sodium restriction plus once-daily spironolactone AND furosemide in a 100:40 ratio. The card carried spironolactone alone, which is half the regimen. The ENDF names cirrhosis with ascites in the furosemide indication itself. Caution Hypersensitivity to sulfonamide-derived drugs Anuria; hepatic disease Severe electrolyte depletion until the condition improves or is corrected Egypt ODEMENT 40MG 10 TAB. EL NASR 1.30 EGP (0.13/unit) FRUZEX 40MG 12 TAB. MISR 3.25 EGP (0.27/unit) FUROSEMIDE 40MG 20 TAB. SEDICO 7.50 EGP (0.38/unit) FURORETIC 40 MG 30 TABS. DEBEIKY > VET... 14.25 EGP (0.47/unit) LAFUREX 40MG 20 TAB. AMOUN 9.50 EGP (0.47/unit) SALEX 40 MG 20 TABS. ARAB DRUG COM... 10.00 EGP (0.50/unit) FUROSEMIDE-ALEX 40MG 20 TAB. ALEXANDRIA 19.00 EGP (0.95/unit) LASIX 40 MG 24 TABS. SANOFI 30.00 EGP (1.25/unit) GENESEMIDE 20MG/5ML SYRUP 120 ML MEDIZEN PHARM... 56.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)