Why is albumin given in peritonitis?

Why is albumin given in peritonitis?

In patients with cirrhosis and spontaneous bacterial peritonitis, treatment with intravenous albumin in addition to an antibiotic reduces the incidence of renal impairment and death in comparison with treatment with an antibiotic alone.

Should albumin be used in all patients with spontaneous bacterial peritonitis?

The Recommendation: We recommend timely administration of 1.5 g/kg of albumin in addition to antibiotics in all patients presenting to the emergency department diagnosed with SBP who also have a serum creatinine >1 mg/dL, BUN >30 mg/dL, or total bilirubin >4 mg/dL.

How is spontaneous bacterial peritonitis diagnosed?

The diagnosis of SBP is established based on positive ascitic fluid bacterial cultures and the detection of an elevated absolute fluid polymorphonuclear neutrophil (PMN) count in the ascites (>250/mm3) without an evident intra-abdominal surgically treatable source of infection [1, 9].

What are the symptoms of spontaneous bacterial peritonitis?

Signs and symptoms of peritonitis include:

• Abdominal pain or tenderness.
• Bloating or a feeling of fullness in your abdomen.
• Fever.
• Nausea and vomiting.
• Loss of appetite.
• Diarrhea.
• Low urine output.
• Thirst.

How does albumin help with spontaneous bacterial peritonitis?

The ability of albumin to improve intravascular volume and bind inflammatory cytokines has led to the study of albumin therapy in patients with SBP. The published literature suggests that albumin in combination with antibiotics prevents renal impairment and reduces mortality in SBP.

What is spontaneous bacterial peritonitis?

Spontaneous bacterial peritonitis (SBP) is defined as an ascitic fluid infection without an evident intra-abdominal surgically treatable source [1].

What is albumin in blood test?

Albumin is a protein made by the liver. A serum albumin test measures the amount of this protein in the clear liquid portion of the blood. Albumin can also be measured in the urine. Blood is drawn from a vein (venipuncture), usually from the inside of the elbow or the back of the hand.

How do you interpret ascitic fluid in SBP?

A high SAAG (>1.1g/dL) suggests the ascitic fluid is a transudate. A low SAAG (<1.1g/dL) suggests the ascitic fluid is an exudate.

How do you calculate serum albumin ascites gradient?

Calculation of SAAG is performed by measuring the serum albumin and ascitic fluid albumin concentrations simultaneously and then subtracting the ascitic fluid albumin from the serum albumin. A SAAG of >1.1 g/dL is 97% accurate in detecting portal hypertension (Fig. 13.2). 3.

How do you calculate PMN in ascitic fluid?

The absolute PMN count in the ascitic fluid is calculated by multiplying the total white blood cell count (or total “nucleated cell” count) by the percentage of PMNs in the differential.

How can you tell the difference between SBP and secondary peritonitis?

SBP is an acute ascites infection an ascitic fluid polymorphonuclear (PMN) cell count of ≥250 cells/mm3 both with or without a positive ascitic fluid bacterial culture. SBP can be differentiated from secondary bacterial peritonitis by the absence of a surgically treatable intra-abdominal source of infection.

What is an albumin challenge?

Standard treatment of ARF and SBP includes albumin infusion [10]. Cirrhotic hemodynamics can easily lead to arterial underfilling. For this reason, an ‘albumin challenge’ at doses of 1 g/kg /day for at least 2 days are recommended to exclude hypovolemic renal failure and to diagnose hepatorenal syndrome (HRS) [11].