In cirrhotic ascites, which diuretic is preferred ?
**Core Concept**
In cirrhotic ascites, the preferred diuretic is one that acts on the renin-angiotensin-aldosterone system (RAAS) to reduce fluid retention and sodium reabsorption in the kidneys. The pathophysiology of cirrhosis involves increased hepatic venous pressure, leading to ascites formation due to sodium and water retention.
**Why the Correct Answer is Right**
Spironolactone is a potassium-sparing diuretic that acts as an aldosterone antagonist, inhibiting the sodium-retaining effects of aldosterone in the collecting ducts of the kidneys. By blocking aldosterone, spironolactone reduces sodium reabsorption and water retention, making it an effective treatment for cirrhotic ascites. This mechanism is particularly beneficial in patients with cirrhosis, as it helps to reduce fluid overload and prevent complications such as hepatic encephalopathy.
**Why Each Wrong Option is Incorrect**
**Option A:** Furosemide is a loop diuretic that acts on the ascending limb of the loop of Henle to increase sodium and water excretion. While furosemide is effective in treating edema and ascites, it can lead to hypokalemia and metabolic alkalosis, which can worsen liver function in patients with cirrhosis.
**Option B:** Acetazolamide is a carbonic anhydrase inhibitor that acts on the proximal convoluted tubule to increase sodium and water excretion. However, acetazolamide is not effective in treating cirrhotic ascites, as it does not address the underlying pathophysiology of sodium and water retention in cirrhosis.
**Option D:** While spironolactone is the preferred diuretic for cirrhotic ascites, the other options are not equally effective or may even be contraindicated in this patient population.
**Clinical Pearl / High-Yield Fact**
In patients with cirrhosis, spironolactone should be used in combination with a loop diuretic like furosemide to enhance diuresis and reduce the risk of hypokalemia. This combination is often referred to as a "spironolactone-furosemide" regimen.
**✓ Correct Answer: C. Spironolactone**