Two Liters of Ascites Drained; Two Days Later This Liver Cancer Patient Suddenly Died

I have previously written two articles specifically on treating hepatic ascites: one is "Rapidly Removing Ascites May Trigger More Serious Hepatorenal Syndrome," and the other is "Qualitative and Quantitative Issues in Treating Ascites." In both articles I stressed that ascites treatment must not be rushed, and that one must not remove too much ascites at once.

I also specifically mentioned that when advanced cancer patients have ascites drawn, a single drainage should preferably be kept under 1000 ml, because the human peritoneum absorbs 100-930 ml of ascites per day; exceeding this maximum easily leads to serious complications, even death.

In this article I want to share what actually happened to a patient in recent days. The patient was a Chinese-Canadian engineer, in China in his early years and later immigrated to Canada. He had liver cancer for many years and had mainly been kept alive in recent years by targeted drugs, but targeted therapy had damaged his kidney function. With advanced liver cancer and poor liver function, he developed jaundice, ascites, and hepatorenal syndrome, and was febrile.

The patient had recently been hospitalized at a local Toronto hospital. The Canadian doctors communicated with the family, telling them the prognosis was poor and asking them to prepare themselves. The patient had long followed my writing and had been in touch with me for several years. At the end, he asked his family to contact me, requesting some help to relieve his suffering.

I suggested treatment with a modified combination of Xiao Chaihu Tang (Minor Bupleurum Decoction) and Yinchen Wuling San. The formula was: Renshen (Ginseng) 10 g, Chaihu (Bupleurum) 12 g, Huangqin (Scutellaria) 12 g, Fabanxia (processed Pinellia) 10 g, Yimucao (Leonurus) 30 g, Fuling (Poria) 30 g, Zhuling (Polyporus) 10 g, Guizhi (Cinnamon Twig) 15 g, Baishao (White Peony) 15 g, Chao Baizhu (fried Atractylodes) 15 g, Hanfangji (Stephania) 15 g, Yinchen (Artemisia) 30 g, Jinqiancao (Lysimachia) 15 g, Rougui (Cinnamon bark) 15 g, Ganjiang (Dried Ginger) 6 g, Zhi Gancao (honey-fried Licorice) 10 g, Shengjiang (Fresh Ginger) 7 slices, Dazao (Jujube) 7 pieces.

Two days after taking the medicine, his condition improved: his temperature fell and he seemed more alert. At this point the local Canadian doctors suggested draining ascites, because the volume was large and they worried his bladder could not tolerate it. I could not make the decision for the patient and his family; they chose to follow the local doctors and had the ascites drained once.

About two liters of ascites were drained in total. After the drainage, the family was very happy, because the abdominal pressure was relieved and the patient briefly showed marked improvement. The family contacted me on March 14, 2025 (Toronto time), telling me that after the ascites was drained the fever was basically controlled, the patient was much more alert than in the previous days, and the drained fluid was amber-colored.

They believed the large volume of ascites was caused by massive intravenous infusion during hospitalization, because before the IV fluids there had not been so much ascites. When I learned that two liters had been drained, I secretly held my breath for the patient. I sent the family the link to my recently written article "Qualitative and Quantitative Issues in Treating Ascites," warning them to watch the patient closely for sudden changes and avoid serious consequences.

By March 16, 2025 (Toronto time), the family contacted me to say the patient had suddenly died. This was somewhat unexpected to me, yet also within my expectations. The patient's condition was indeed severe, so death in the near future was probably inevitable. But draining the ascites so abruptly objectively accelerated his death. On the bright side, it helped him leave sooner and suffer less; on the downside, it may also have cost him a chance to prolong his life.

This is something I have often encountered over the years. It is not about the dispute between Chinese and Western medicine; when unavoidable, I support gradual ascites drainage. In fact, in "Qualitative and Quantitative Issues in Treating Ascites," I discussed not so much TCM methods as Western methods and principles of ascites management. Draining more than one liter at once is, frankly, rather barbaric treatment that violates basic physiology. So the patient's sudden death is not surprising.

The brief, marked improvement after drainage had left the family unable to contain their excitement. But only two days later, that excitement was replaced by grief. I really do not want sad cases to illustrate my points, but sadly, just days after I wrote that article, such a case appeared.

I write this hoping that patients, families, and oncologists will pay attention to the "quantitative" issue in ascites treatment, not rush, and not achieve the opposite of what is intended. Treating a major illness is like cooking a small fish: it requires calmness and patience, following basic physiological rules. Do not focus only on the fleeting, immediate effect while ignoring the larger risk.