Ascites - Frequently Asked Questions

Frequently Asked Questions

1. Who is the specialist I should consult when I notice ascites?

Ascites is treated by a gastroenterologist who will examine the patient first, and may then redirect the patient to another specialist depending on the cause of the Ascites.

2. What are the tests that should be done on the ascitic fluid?

The most important tests include:

• The W.B.C or the white blood cell count to determine the presence of infection.

An increase in the count with predominant neutrophils is suggestive of bacterial infection and antibiotics should be started.

An increase in lymphocytes suggests tuberculosis or malignancy in the patient.

• Albumin concentration to calculate the SAAG and determine the type of ascites.
• Culture to isolate the causative organisms in case of infection.
• Total protein concentration to determine patients who are at high risk for developing spontaneous bacterial peritonitis.
• Amylase activity, which is elevated in pancreatic ascites and gut perforation.
• Gram Stain can be helpful in gut perforation when multiple types of bacteria are seen.
• Cytology of ascitic fluid helps in detecting ascites due to cancer when the peritoneum is involved.

3. How do I manage a low salt diet?

Try to limit your salt intake to 1 teaspoon a day or less than 2000mg a day. Avoid processed and canned foods, salted nuts, pickles, fried chips among others.Prepare a diet chart and make a list of food to be avoided and follow it strictly.


4. How can food taste good without salt?

Try adding lemon juice, herbs and spice mixes to enhance the taste of food. Avoid salt substitutes as they have too much potassium.

5. What about sugar and fats?

There is no problem if you have it in moderation. But if you have diabetes or hypertension, you need to control this and be more careful.

6. With so much fluid, don't I need to restrict water?

It is the sodium restriction that is important, fluid restriction in all patients with ascites is inappropriate. Only in severe hyponatremia when the sodium level drops to 120mEq/l in a patient with ascites, fluid restriction is indicated.

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