Contributor: Sam Killian, MD

Educational Pearls:

• Patients with cirrhosis and ascites are frequently evaluated for spontaneous bacterial peritonitis, an infection of the ascites fluid that is not from a surgically treated source
• Fever, abdominal pain, and altered mental status should all raise clinical suspicion in a patient with ascites
• Fluid from paracentesis may show increased WBCS (polys and neutrophils), high LDH, high amylase, and decreased glucose
• Outcomes are very poor in these patients with 30-40% of these patients continue to renal failure with 60-80% in-hospital mortality
• Typically treat with a third generation cephalosporin or ampicillin+gentamicin

References

Long B, Koyfman A. The emergency medicine evaluation and management of the patient with cirrhosis. Am J Emerg Med. 2018;36(4):689-698. doi:10.1016/j.ajem.2017.12.047

MacIntosh T. Emergency Management of Spontaneous Bacterial Peritonitis - A Clinical Review. Cureus. 2018;10(3):e2253. Published 2018 Mar 1. doi:10.7759/cureus.2253

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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