Treatment of Complications of Cirrhosis

• Complication Treatment Dosage

• Ascites Sodium restriction Maximum 2,000 mg per day Spironolactone (Aldactone) Start 100 mg orally per day; maximum

• 400 mg orally per day

• Furosemide (Lasix)Start 40 mg orally per day; maximum 160 mg orally per day

• Albumin 8 to 10 g IV per liter of fluid (if greater than 5 L) removed for paracenteses

• Fluid restriction Recommended if serum sodium is less than 120 to 125 mEq per L (120 to 125 mmol per L)

• SBP Cefotaxime (Claforan) 2 g IV every eight hours

• Albumin 1.5 g per kg IV within six hours of detection and 1 g per kg IV on day 3

• Norfloxacin (Noroxin)† 400 mg orally two times per day for treatment

• 400 mg orally two times per day for seven days with gastrointestinal hemorrhage

• 400 mg orally per day for prophylaxis

• Trimethoprim/sulfamethoxazole (Bactrim) 1 single-strength tablet orally per day for prophylaxis

• 1 single-strength tablet orally two times per day for seven days with gastrointestinal hemorrhage

• Hepatic encephalopathy Lactulose 30 to 45 mL syrup orally titrated up to three or four times per day or 300 mL retention enema until two to four bowel movements per day and mental status improvement

• Neomycin 4 to 12 g orally per day divided every six to eight hours; can be added to lactulose in patients who are refractory to lactulose alone

• Portal hypertension Propranolol (Inderal) 40 to 80 mg orally two times per day

• Isosorbide mononitrate (Ismo) 20 mg orally two times per day

• Hepatorenal syndrome Midodrine (ProAmatine) and ) Dosed orally (midodrine) and IV (octreotide) to Octreotide (ASandostatin) obtain a stable increase of at least 15 mm Hg mean arterial pressure

• Dopamine 2 to 4 mcg per kg per minute IV (nonpressor dosing to produce renal vasodilatation