Table 4.

Diagnosis and therapy of ascites

Uncomplicated ascites				Recurrent ascites	Refractory ascites
	Grade 1	Grade 2	Grade 3
Definition	Mild ascites only detectable by ultrasound	Moderate ascites evident by moderate abdominal distension	Tense ascites with marked abdominal distension	Ascites that is associated with frequent LVP (at least 3 within 12 months) despite optimal treatment	Ascites that cannot be mobilized or with early recurrence due to lack of response to sodium restriction and diuretic treatment; impaired urinary sodium excretion (< 80 mmol/24 h); spot urinary sodium/potassium ratio < 2.5
Treatment	Moderate sodium restriction	Moderate sodium restriction and MRAs, if not responsive additional loop diuretic	Paracentesis, sodium restriction, and diuretics Evaluation for OLT	TIPS or repetitive large volume paracentesis OLT must be considered
Avoid	NSAIDs, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, α1-adrenergic receptor blockers, aminoglycosides		NSAIDs, angiotensin converting enzyme inhibitors, angiotensin receptor blockers α1-adrenergic receptor blockers, aminoglycosides, carvedilol if hypotensive, propranolol with caution (not more than 80 mg/day)