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 Best of Five 3.60

 

   

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BOF: 3.60

A 47-year-old male who is known to have alcoholic liver disease with established cirrhosis is admitted to your ward with worsening ascites. He has a paracentesis and is subsequently commenced on spironolactone 200 mgs daily and furosemide 40 mgs daily. There was no evidence of spontaneous bacterial peritonitis on the ascitic fluid samples sent to the laboratory.

Over the next few days his urine output begins to decrease and there is a rise in his serum creatinine levels to 240 μmol/L (normal range serum creatinine 60 110 μmol/L). Abdominal ultrasound scan has shown normal sized kidneys and no evidence of obstructive uropathy. Urine dipstick examination does not show proteins or blood. You stop the diuretics, ensure that there is no salt and water depletion and start the patient on infusions of albumin.

In addition to the above which of the following is likely to be of benefit to the patient?

a)      Intravenous furosemide

b)      Dopamine infusion

c)     Dobutamine infusion

d)      Octreotide infusion

e)      Intravenous terlipressin

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