Development of Refractory Ascites during Amiodarone Therapy in a Hemodialysis Patient with Nephrogenic and Cardiogenic Ascites

Figures & data

Figure 1.  (A) Nonenhanced computerized tomography showing right-side pleural effusion and no pericardial effusion. (B) Nonenhanced computerized tomography showing moderate ascites in both the right perihepatic space and the left perisplenic space, slightly diminished size and slightly uneven surface of liver, periportal edema, and no splenomegaly.

Table 1.  Laboratory analyses of three episodes of ascites.

	First (23 September 2008)	Second (8 July 2009)	Third (23 September 2009)
Appearance	Watery	Watery	Watery
Color	Bloody	Straw	Straw
Transparency	Turbid	Turbid	Turbid
Specific gravity	1.016	1.024	1.026
Serum total protein (g/dL)	6.6	7.4	8.9
Serum albumin (g/dL)	3.1	3.5	3.7
Ascites total protein (g/dL)	2.5	4.1	4.9
Ascites albumin (g/dL)	0.9	1.9	Omitted
SAAG	2.2	1.6	Omitted
Ascites RBC (/mm^3)	20,000	17,560	10,880
Ascites WBC (/mm^3)	700	54	200
Ascites neutrophil (%)	5	32	17
Ascites monocyte (%)	95	68	83
Cytology	Negative	Negative	Negative
Bacterial culture	Negative	Negative	Negative
Mycobacteria culture	Negative	NA	NA
Ascites glucose (mg/dL)	136	NA	103
Ascites LDH (IU/L)	NA	NA	250
Ascites fluid urea (mg/dL)	NA	NA	23.9
Ascites triglyceride (mg/dL)	NA	NA	20
Ascites amylase (IU/L)	NA	NA	12

Notes: SAAG, serum ascites albumin gradient; RBC, red blood cell; WBC, white blood cell, LDH, lactate dehydrogenase; NA, not available