Ascites - Frequently Asked Questions

Q: Who is the specialist I should consult when I notice ascites?

A: 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.

Q: What are the tests that should be done on the ascitic fluid?

A: 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.

Q: How do I manage a low salt diet?

A: 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.

Q: How can food taste good without salt?

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

Q: What about sugar and fats?

A: 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.

Q: With so much fluid, don’t I need to restrict water?

A: 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.