-Diurese to reduce weight by 0.5-1 kg/d (if edema) or 0.25 kg/d (if no edema). -Spironolactone (Aldactone) 25-50 mg PO qid or 200 mg PO qAM, increase by 100 mg/d to max of 400 mg/d. -Furosemide (Lasix)(refractory ascites) 40-120 mg PO or IVqd-bid. Add KCL
20-40 mEq PO qAM if renal function is normal OR -Torsemide (Demadex) 20-40 mg PO/IV qd-bid. -Metolazone (Zaroxolyn) 5-10 mg PO qd (max 20 mg/d). -Ranitidine (Zantac) 150 mg PO bid. -Vitamin K 10 mg SQ qd for 3d. -Folic acid 1 mg PO qd. -Thiamine 100 mg PO qd. -Multivitamin PO qd.
Paracentesis: Remove up to 5 L of ascites if peripheral edema, tense ascites, or decreased diaphragmatic excursion. If large volume paracentesis without peripheral edema or with renal insuffiencey, give salt-poor albumin, 12.5 gm for each 2 liters of fluid removed (50 mL of 25%
solution); infuse 25 mL before paracentesis and 25 mL 6h after.
10. Symptomatic Medications: -Docusate sodium (Colace) 100 mg PO qhs. -Lactulose 30 mL PO bid-qid.
11. Extras: KUB, CXR, abdominal ultrasound, liver-spleen scan, GI consult.
12. Labs: Ammonia, CBC, SMA 7&12, LFTs, albumin, amylase, lipase, INR/PTT. Urine creatinine, Na, K. HBsAg, anti-HBs, hepatitis C virus antibody, alpha-1-antitrypsin.
Tube 1: Protein, albumin, specific gravity, glucose, bilirubin, amylase, lipase, triglyceride, LDH (3-5 mL, red top tube). Tube 2: Cell count and differential (3-5 mL, purple top tube). Tube 3: C&S, Gram stain, AFB, fungal (5-20 mL); inject 20 mL into blood culture bottles at bedside. Tube 4: Cytology (>20 mL). Syringe: pH (2 mL).
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Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.