Tolvaptan is effective in treating patients with refractory ascites due to cirrhosis

Cases with Refractory Ascites and a Delayed Response to Tolvaptan

The patient was a 67-year-old female with liver cirrhosis due to hepatitis C. She was administered furosemide at 20 mg/day and spironolactone at 25 mg/day, but the ascites did not improve. Despite the additional administration of tolvaptan at 3.75 mg/day, the response to ascites was still poor. While the dose of tolvaptan was thereafter increased to 7.5 mg/day on the 7th hospital day, the ascit...

Methylene Blue Is Effective to Reverse Refractory Hemodynamic Instability due to Dimethoate Poisoning

Background:Organophosphates are commercially available agrochemicals for pest control, but may be abused for deliberate self-poisoning. We report a case of suicidal ingestion of dimethoate, a moderately toxic organophosphate insecticide, which can cause refractory hemodynamic instability, and the successful use of methylene blue (MB) for counteracting this complication. Case Presentation: An u...

Ascites, refractory ascites and hyponatremia in cirrhosis

Ascites is the most common complication related to cirrhosis and is associated with increased morbidity and mortality. Ascites is a consequence of the loss of compensatory mechanisms to maintain the overall effective arterial blood volume due to worsening splanchnic arterial vasodilation as a result of clinically significant portal hypertension. In order to maintain effective arterial blood vol...

Tolvaptan for the Treatment of Refractory Ascites

To the Editor: The findings from a Japanese phase 3 trial revealed that tolvaptan (Otsuka Pharmaceutical, Osaka, Japan), a non-peptide antagonist of the vasopressin type 2 receptor, is effective in the treatment of refractory ascites in cirrhotic patients. Although this agent is now widely used in clinical practice, few reports have so far been published regarding its real-world efficacy. The r...

Management of adult patients with ascites due to cirrhosis.