mittelschmerzIn portal HTN, the splanchnic vasodilation results in a drop in systemic BP and renal hypoperfusion. That leads to RAAS activation that increases SBP enough to maintain renal perfusion, but the aldosterone-mediated Na/H2O retention leads to edematous states (ascites here). Treating with spironolactone allows you to treat the the fluid component without disrupting the vasoconstrictive effects of AngII that is the only thing maintaining renal perfusion, which is why spironolactone is correct here, but also why prescribing an ACEi or ARB in a hepatic patient like this is v v bad. +15
nbmesucksI just took it as this guy is on a loop diuretic so he's gonna lose his potassium. So to minimize this we give a potassium sparing diuretic.+6
submitted by โcassdawg(1780)
Spironolactone has a special use in hepatic ascites (FA2020 p609).
Spironolactone is the drug of choice for initial treatment of ascites due to cirrhosis