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Paracentesis
Todd W. Thomsen, M.D., Robert W. Shaffer, M.D., Benjamin White, M.D.,
and Gary S.Setnik, M.D.
INDICATIONS

Abdominal paracentesis should be performed in all adult patients presenting with
new-onset ascites of uncertain causation. Evaluation of the ascitic fluid will determinewhether the ascites is due to portal hypertension or to another process, such
as cancer, infection, or pancreatitis.1,2
Diagnostic paracentesis should also be performed in patients with preexistingascites when spontaneous bacterial peritonitis (SBP) is suspected. SBP is common in
patients with ascites and may be life-threatening; clinical indicators include fever,
abdominal pain, worseningencephalopathy, worsening renal function, leukocytosis,
acidosis, gastrointestinal bleeding, sepsis, and shock.2 In addition, some experts recommend that all patients with cirrhosis and ascitesrequiring hospitalization undergo
a surveillance paracentesis, since occult SBP is not uncommon in these patients.1
Large-volume paracentesis may be performed to alleviate discomfort or respiratorycompromise in patients with tense ascites who are in hemodynamically stable condition.3 Serial large-volume paracenteses may be required in patients with refractory
ascites or ascites that does notrespond to diuretics.

From the Department of Emergency Med­
icine, Mount Auburn Hospital, Cambridge,
MA (T.W.T., R.W.S., G.S.S.); the Depart­
ment of Emergency Medicine, Brigham
and Women’sHospital, Boston (B.W.); and
the Division of Emergency Medicine,
Harvard Medical School, Boston (T.W.T.,
R .W.S., B.W., G.S.S.). Address reprint re ­
quests to Dr. Thomsen at the Department
of EmergencyMedicine, Mount Auburn
Hospital, 330 Mount Auburn St., Cam­
bridge, MA 02238, or at tthomsen@mah.
harvard.edu.
N Engl J Med 2006;355:e21.
Copyright © 2006 Massachusetts Medical Society....