Why is hypovolemia a concern during paracentesis?

Why is hypovolemia a concern during paracentesis?

• A. Electrolyte imbalance
• B. Albumin drop causing intravascular volume shift
• C. Increased urine output
• D. Hypoglycemia

Answer: (B)

During paracentesis, removing a large amount of ascitic fluid can lower the effective circulating volume, and in patients with cirrhosis this risk is amplified by existing circulatory abnormalities. Albumin helps keep fluid inside the blood vessels by maintaining oncotic pressure; when a big volume is removed, especially if albumin is also reduced with the ascitic fluid, the oncotic pressure falls and fluid shifts from the intravascular space into the interstitial and third spaces. This can lead to hypovolemia and reduced renal perfusion. Giving albumin after large-volume paracentesis helps prevent this intravascular volume loss and circulatory dysfunction.

During paracentesis, removing a large amount of ascitic fluid can lower the effective circulating volume, and in patients with cirrhosis this risk is amplified by existing circulatory abnormalities. Albumin helps keep fluid inside the blood vessels by maintaining oncotic pressure; when a big volume is removed, especially if albumin is also reduced with the ascitic fluid, the oncotic pressure falls and fluid shifts from the intravascular space into the interstitial and third spaces. This can lead to hypovolemia and reduced renal perfusion. Giving albumin after large-volume paracentesis helps prevent this intravascular volume loss and circulatory dysfunction.