Rapidly Removing Ascites May Trigger More Serious Hepatorenal Syndrome
Patients with cirrhosis or advanced tumors may develop ascites. Most people, upon encountering ascites, instinctively hope it will disappear immediately. But in fact, all the methods that remove ascites in a short period carry hidden dangers. Therefore, when a patient goes to the hospital to have ascites drawn, an experienced clinician will not use short-term large-volume paracentesis, but will instead drain only a portion of the ascites each time, while supplementing the patient with albumin; some doctors even instill some chemotherapy drugs into the abdominal cavity. This prevents the patient from developing visceral congestion due to too-rapid resolution of ascites and a sudden drop in intra-abdominal pressure, which would otherwise lead to hepatorenal syndrome.
Hepatorenal syndrome (HRS) is a very fatal complication that often occurs in patients with advanced tumors or cirrhosis. Because in such patients both renal and hepatic functions fail simultaneously, the prognosis is poor. HRS has two subtypes: if renal function deteriorates sharply within 2 weeks, it is type 1; if renal function deteriorates slowly over several months, it is type 2. Usually, type 1 HRS patients who do not receive timely treatment die within 2 weeks; type 2 HRS patients who do not receive timely treatment also die within half a year. At present, the only cure for HRS is liver transplantation; other symptomatic supportive treatments can only buy time for the transplant.
Although most cases of HRS are caused by systemic hemodynamic disturbances and neurohormonal imbalance due to liver disease, in tumor or cirrhosis patients quite a few are caused by improper management of ascites. Overuse of diuretics or large-volume paracentesis are the most common triggers of HRS in cirrhosis or tumor patients. This happens when patients and their families are impatient for results and hope ascites will clear quickly. For example, some patients may simultaneously receive ascites treatment from several doctors, all of whom use diuretics; stacking several diuretics inevitably leads to over-diuresis.
Other patients use excessively harsh diuretics, such as the TCM formula Shizao Tang (Ten-Jujube Decoction) or Pengzheng Wan (Distention-Relieving Pill). Such drugs may make a patient's ascites disappear overnight or within a few days, but the patient's lifespan is also shortened as a result. The root cause is improper treatment triggering hepatorenal syndrome. If a patient has low albumin, such drugs must be used very cautiously.
A prudent way to treat ascites is to remove it step by step while supplementing the patient with albumin, strengthening nutrition, and improving physical strength. This may be a slow process requiring the cooperation of the patient and family. As long as the ascites shows a trend of decreasing and the patient's strength is improving, it is worth waiting patiently.
Traditional TCM has many approaches to treating ascites, among which the harsh purgative and diuretic approach is the least advisable. Yet in practice I find that this fast-acting method, which brings endless future trouble, is actually the one most welcomed by patients and families. Many clinicians with limited experience in treating ascites also like to use Shizao Tang, Zilong Wan, Pengzheng Wan, Daji (Euphorbiae Pekinensis Radix), Yuanhua (Genkwa Flos), Badou shuang (croton butter), Qianniuzi (Pharbitidis Semen), and similar drugs; only after the patient develops HRS do they feel helpless. The patient and family also assume the disease has simply become this severe and resign themselves to fate.
In fact, if we draw on modern medical knowledge to understand the underlying mechanism, treat more cautiously, and choose safer plans rather than rushing for results, patients often survive longer and enjoy a better subsequent quality of life.