Intravenous Infusion of Dialyzed, Autogenous, Ascitic Fluid in the Management of Cirrhotic Ascites
RICHARD C. BRITTON, M.D.
Department of Vascular Surgery
SATORU NAKAMOTO, M.D.
Department of Artificial Organs
IN recent years the traditional treatment of repeated paracenteses in the management of cirrhotic ascites has waned in favor of attempts to correct underlying physiologic defects. The relative importance of abnormal renal tubular absorption of sodium, portal hypertension, abnormal osmoreceptor responses, secondary aldosteronism, and reduced protein oncotic pressure in the formation of cirrhotic ascites has been shown.1–6 Sodium retention appears to be basic to the formation of ascites and, in many patients, strict salt restriction is sufficient to control ascites.7–9 However, in patients with imminent or actual hemorrhage from esophageal varices, prolonged dietary measures are impractical and potentially dangerous. A reduced surgical mortality in patients free of ascites has been the impetus for seeking a safe rapid means of eliminating or controlling ascites.10
Repeated paracenteses reduce total body sodium, but also have the disadvantage of depleting plasma proteins. Infusion of ascitic fluid intravenously has been advocated in the past, but this amounts to a transfer of sodium and water from one extracellular space to another, and the volumes to be infused are prohibitive.11–13
Intravenous infusion of concentrated ascitic fluid without water and sodium and with conservation of proteins would be most desirable. This report describes a method of concentrating ascitic fluid and rendering it sodium poor. Such concentration is possible by ultrafiltration and dialysis. This technic has proved practical in nine dialyses of ascitic fluid from six cirrhotic patients. No serious reactions occurred, and ascites formation was arrested after single treatments in five patients, and after four treatments in one . . .