When is albumin required after paracentesis and at what dose?

Large-volume paracentesis (LVP) >5 liters: albumin 6 to 8 g/L removed significantly reduces PPCD (circulatory dysfunction, renal impairment, dilutional hyponatremia) vs crystalloid or dextran. Standard: 8 g/L removed for first 5 L, then 8 g/L thereafter. Paracentesis <5 L: albumin not routinely required (crystalloid or no replacement acceptable).

Can dextran or gelatin be used instead of albumin after paracentesis?

No synthetic colloid is as effective as albumin for PPCD prevention. Dextran-70 (8 g/L) is intermediate (significant vs no albumin, inferior to albumin). Gelatin and HES are inferior. 20% albumin (200 mL per 5 L removed) preferred over 4 to 5% formulations for lower volume and cost in LVP. Albumin reduces 90-day mortality in SBP treatment.

Albumin Infusion Volume for Large-Volume Paracentesis

Calculate post-paracentesis albumin infusion volume: 6 to 8 g per liter of ascites removed (for drainage >5 liters) to prevent post-paracentesis circulatory dysfunction (PPCD) and hepatorenal syndrome.

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Frequently Asked Questions

When is albumin required after paracentesis and at what dose?

Can dextran or gelatin be used instead of albumin after paracentesis?