What to do with all that fluid?

EXAMPLE:
At yesterday’s morning report in Parkland we had a great discussion about treating ascites. Below is a link to the most updated guidelines regarding ascites management in cirrhosis from the American Association for the Study of Liver Diseases (AASLD) published in February 2013.

http://www.aasld.org/practiceguidelines/Documents/ascitesupdate2013.pdf

Some key points from the guidelines include:
-Since bleeding is uncommon during diagnostic paracentesis, routine prophylactic use of platelets and fresh frozen plasma are not recommended (Class III, Level C).
-Initial laboratory tests for ascitic fluid should include cell differential count, ascitic total protein and SAAG (Class I, Level B).
-Sodium restriction (less than 2000mg per day) and diuretics (spironolactone with or without furosemide) is first line therapy in cirrhotics with ascites (Class IIa, Level A).

Once a week antibiotics? Interesting NEJM Article!

This week at morning report we discussed about the increasing prevalence of multi-drug resistant organisms making it harder for clinicians to treat patients with severe infections. In the most recent issue of The New England Journal of Medicine, a trial was published that looked at once a week dosing versus daily dosing of antibiotics for skin infections. Click on the link below to read the article!

http://www.nejm.org/doi/full/10.1056/NEJMoa1310480

NEJm article

 

UTSW Internal Medicine

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