Management

1. Ascites

• Take specimens for microbiological analysis (including TB), protein and cytology. If WBC > 250 per high power field, give Gram negative antibiotic cover.

• If present in large quantity, (i) decrease sodium and water intake, (ii) commence spironolactone PO (or potassium canrenoate IV) ± furosemide. Paracentesis ± colloid replacement, or ascitic reinfusion (if uninfected/non-pancreatitic in origin) may be considered, particularly if diaphragmatic splinting occurs.

2. Coagulopathy:

• Vitamin K 10mg/day slow IV bolus for 2-3 days.

• Fresh frozen plasma, platelets as necessary.

3. Hypoglycaemia — should be prevented by adequate nutrition or a 10% or 20% glucose infusion.

4. Adequate nutrition and vitamin supplementation.

5. Acute decompensation — avoid any precipitating causes, e.g. infection, sedation, hypovolaemia, electrolyte imbalance.

6. Drug administration — review type and dose regularly.

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