A patient with severe end stage liver disease, cirrhosis from EtOH and hepatitis C, presents with several days of low grade fever, diffuse continuous abdominal pain and tenderness, altered mental status, and diarrhea. On exam, you notice a fluid wave ascites and decide to tap it for paracentesis.
Challenge: What are you looking for when you analyze the fluid?
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3 comments:
ammonia?
spontaneous bacterial peritonitis! look for WBC > 50K, positive gram stain, exudative SAAG.
Happy Christmas! I like Steph's answer, but I also found this interesting 1962 article about ammonia
http://www.ncbi.nlm.nih.gov/pubmed/14469419
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Not to be Confused with Systolic Blood Pressure
SBP can also mean spontaneous bacterial peritonitis, an ascitic fluid infection without an evident intra-abdominal surgically-treatable source. It primarily occurs in patients with severe cirrhosis. The diagnosis is made by a positive ascitic fluid bacterial culture or elevated PMN count >250 cells/mm3.
Source: UpToDate.
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