The ascites associated with liver failure is secondary to portal hypertension (seen in cirrhosis, hepatocellular cancer and extensive hepatic metastases).
The ascitic fluid has a relatively low albumin concentration, a difference of >11g/L between serum and ascitic fluid. This often responds well to a median daily dose of 200-300mg spironolactone, with up to 90% of cirrhotic patients noticing a benefit.
If a patient fails to respond to or tolerate diuretic treatment, paracentesis can be considered. If a patient requires frequent paracentesis, a tunnelled drain can be considered, depending on the prognosis. Contact your local service for further advice.