Previously, spironolactone was usually given alone, but experts now use it by itself only in patients with minimal fluid build-up. Weight loss from diuretics usually should not exceed one or two pounds a day, but there is no limit for patients with massive swelling. Restricting fluid is not usually necessary unless sodium levels in the blood are very low. Physicians often recommend bed rest for patients with ascites, but many experts believe this is not necessary and say that studies do not support its benefits. If diuretics are not successful and the ascites is very tense, patients may require large-volume paracentesis.
Research indicates that four to six liters is usually effective and safe.
If the ascites does not respond to treatments, paracentesis may need to be repeated every two weeks or more frequently and up to 10 liters may need to be removed. Patients who require this are probably not complying with dietary requirements. This procedure does not improve survival, however, and can have serious complications, including infection, blood clots, and rupture of blood vessels in the esophagus. It is now reserved for patients who are not candidates for repeat paracentesis or liver transplantation. Procedures for Preventing and Treating Variceal Bleeding Endoscopic Sclerotherapy.