A large amount of ascites, also referred to as severe or massive ascites, is an excessive accumulation of fluid in the abdominal cavity that causes significant abdominal distension, discomfort, and often difficulty breathing. This condition is a sign of serious underlying illness, most commonly advanced liver disease (cirrhosis), but also cancer or heart failure.
The fluid volume is usually >500 mL. 3) Severe ascites (grade 3) causes abdominal distension accompanied by flattening of the umbilicus or umbilical hernia. Dyspnea indicates that the peritoneal fluid volume is large, up to ~5 to 15 L.
Ascites is a condition that happens when fluid collects in spaces in your belly (abdomen). If severe, it may be painful. The problem may keep you from moving around comfortably. It can set the stage for an infection in your abdomen. Fluid may also move into your chest and surround your lungs.
Case report: In this case report, we describe a rare case of amlodipine induced massive ascites in a 30-year-old male with renal transplantation. Conclusion: We aimed to create awareness that pharmacologic causes should be considered in cases of ascites of unknown aetiology.
Patients may accumulate as much as 10-15 liters of ascites every 15 days. When large quantities of ascites accumulate in the abdominal cavity, the sheer volume of liquid puts pressure on the surrounding organs such as the bladder, stomach and even diaphragm.
Malignant ascites can occur in patients with colon, pancreatic, breast, and lung primaries with the development of peritoneal carcinomatosis. The life expectancy of such patients is generally limited to weeks to months after the onset of ascites.
AASLD guidelines state there is no limit in the amount of ascites that can be drained in a single session if 6-8 grams of albumin replacement is given for each liter of ascites drained [1]. However, paracentesis greater than 8 liters has been associated with a greater risk of PPCD [1,4].
Amlodipine and nifedipine are common drugs associated with vasodilatory edema. When used as monotherapy, calcium channel blockers (CCBs) are associated with a substantial risk of peripheral edema, including pedal edema, which is the most common reason for its discontinuation.
The severity of liver injury from amlodipine ranges from mild and transient serum enzyme elevations to self-limited jaundice. Complete recovery is expected after stopping the drug and recovery is usually rapid (4 to 8 weeks). Cases with chronic or fulminant liver injury due to amlodipine have not been reported.
CCB-related chylous ascites is defined as white milky ascites/effluents that appear after administration of CCBs. Physicians must be aware of the possibility of chylous ascites when administering CCBs, particularly in patients with renal function impairment and ESRD patients undergoing PD.
Ascites (/əˈsaɪtiz/; Greek: ἀσκός, romanized: askos, meaning "bag" or "sac") is the abnormal build-up of fluid in the abdomen. Technically, it is more than 25 millilitres (0.88 imp fl oz; 0.85 US fl oz) of fluid in the peritoneal cavity, although volumes greater than one litre (0.22 imp gal; 0.26 US gal) may occur.
Diagnosis is based on physical examination and often abdominal ultrasound or CT scan. Treatments include dietary sodium restriction, diuretics, and therapeutic paracentesis. Ascitic fluid can become infected (spontaneous bacterial peritonitis), often causing pain and fever.
Ultrasound has significant accuracy to distinguish transudate and exudate ascites and in suggesting the underlying cause.
Ascites refers to the abnormal accumulation of fluid within the peritoneal cavity, most frequently associated with cirrhosis, but also linked to heart, kidney, pancreatic, and malignant diseases.
The International Ascites Club classifies the severity classification of ascites as follows: Mild ascites (grade 1): ascites only detectable by ultrasound. Moderate ascites (grade 2): moderate abdominal distention. Large ascites (grade 3): marked abdominal distention.
The subdiaphragmatic and paracolonic measurements are performed in the transverse section, while the space anterior to the urinary bladder is evaluated in the sagittal section. The volume of ascites is calculated according to the following formula: fluid volume = ([A + B + C + D + E] × 200 [mL])(22).
Common side effects
Acetaminophen or Tylenol® is the best known medication that can damage the liver. This medication is widely available without prescription and is present in many of the cold and flu remedies as well as in prescribed pain medications.
Early signs your liver is struggling often include persistent fatigue, unexplained weight loss, loss of appetite, nausea, abdominal pain/bloating (especially upper right), and itchy skin, with changes in urine/stool color and easy bruising also being key indicators, though sometimes symptoms are absent in early stages. Pay attention to changes like dark urine, pale stools, or jaundice (yellow skin/eyes), as these signal the liver isn't filtering toxins or processing bilirubin properly.
Alpha-blockers and Alpha-2 agonists are not recommended as first-choice treatment for high blood pressure. Beta-blockers can worsen asthma symptoms and other lung conditions. Vasodilators and loop diuretics present a risk of serious side effects.
Swelling from amlodipine is a common, but often troublesome side effect of amlodipine with 5% to 9% of people stopping amlodipine because of it. If you develop swelling with amlodipine, tell your doctor right away because they may be able to change your blood pressure medications slightly to help reduce the swelling.
The extra fluid in your body can raise your blood pressure and force your heart to work harder. It can also make it hard for you to breathe.
Abdominal fluid can leak into your chest and lungs, causing shortness of breath, cough and hypoxemia (lack of oxygen in your blood). You may need thoracentesis to remove the fluid. Ascites-related hernias. The increase in abdominal pressure can lead to hernias.
So your medical team will find a balance where they can safely take as much fluid as possible. The drain should not stay in place for more than 6 hours. If ascites keeps coming back, you might have regular appointments at your hospital's ascites clinic to get the fluid drained.
For therapeutic paracentesis, the amount of fluid depends on how much excess fluid you have and whether you have a history of fluid returning. Often, removing 5 liters is enough to relieve abdominal pressure from ascites. Your provider may remove more fluid if your ascites often return (recur).