A 60-year-old man with a known case of Hemochromatosis, cirrhosis and poal hypeension was brought to ED with altered mental status. Attendant describes that since the last 3 days ,the patient is confused , no h/o melena or hematemesis. For chronic ascites , diet control and spironolactone is given regularly . In the past he had an episode of variceal bleed for which he was put on propranolol and no episodes are seen since then. On examination he is not well oriented to time , place , but oriented to person .He is afebrile , vitals are stable , but ascites, asterixis, are notable. His laboratory investigation shows hemoglobin of 10.1 , Creatinine of 1.4 , and Blood urea nitrogen of 45. On paracentesis, clear fluid with 800 WBC (40% neutrophils) were seen. False statement regarding this condition:
SBP- severe complication of ascites characterized by spontaneous infection of the ascitic fluid without an intra-abdominal source. Fluid is a transudate due to cirrhosis protein is <2.5 g/dl. Patients with ascites may present with Fever Altered mental status Abdominal pain or discomfo Elevated WBC count Bacterial translocation -gut flora traversing the intestine into mesenteric lymph nodes, leading to bacteremia and seeding of the ascitic fluid. MC organisms- E. coli and other gut bacteria. Absolute neutrophil count >250/mL. Bedside cultures should be obtained when ascitic fluid is tapped Diagnosis: Ascitic tap having neutrophil count >250/mL is diagnostic Treatment: Cefotaxime (best drug) Prophylaxis: Required in a patient with an episode(s) of SBP or who had recovered. Once-weekly dosing of antibiotics.
Ascites is preceded by infection
Clinical features are abdominal pain, fever, leucocytosis and altered mental status
Ascitic fluid protein of 1 gm/dl
Common organisms are Gram negative organisms
Cirrhosis