Effect of intravenous mannitol in mobilization of resistant cirrhotic ascites

Abstract

Cirrhotic ascites is conventionally treated with bed rest, salt restriction, and diuretics. In 20-30% of patients it eventually became resistant to diuretic therapy partly because of reduced sodium excretion owing to the development of resistance against atrial natriuretic peptide. Diuretics resistance can be overcome partially by increasing distal tubular sodium delivery by atrial natriuretic peptide and mannitol administration. To determine the short-term response of intravenous mannitol administration on mobilization of resistant cirrhotic ascites in addition to conventional diuretic treatment. It was an interventional, experimental (double-blind randomized controlled) study conducted in the medical department of Jinnah Hospital, Lahore. A total of 60 patients meeting inclusion and exclusion criteria were included in the study, 30 each in mannitol and placebo groups. Patients were followed for 5 days after the administration with mannitol or placebo. Main outcome measures were increase in 24 h urinary sodium, increase in urinary volume, decrease in weight and abdominal girth. Data showed that all the parameters of response, that is increase in 24 h urinary sodium (cases 34.09±16.71 vs. control 19.16±13.22, P=0.000), increase in urinary volume (cases 260.00±73.58 vs. control 91.67±43.71) decrease in weight (cases 3.07±1.14 vs. control 2.3±1.08, P=0.010) and decrease in abdominal girth (cases 4.70±2.86 vs. control 2.07±1.41, P=0.000) on day 5 of treatment were in favor of mannitol administration. This study shows that resistant ascites can be initially mobilized by infusion of mannitol. The long-term benefits of such therapy are unknown.