American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with ascites who cannot tolerate diuretics, which treatment is typically administered?

1. Intravenous fluids

2. Large-volume paracentesis

3. Dialysis

4. Transfusion of red blood cells

The correct answer is: Large-volume paracentesis

In patients with ascites who cannot tolerate diuretics, large-volume paracentesis is a commonly administered treatment. This procedure involves the removal of excess fluid from the abdominal cavity, which can relieve discomfort, improve breathing, and allow for better mobility. Unlike diuretics, which work systemically and may exacerbate issues like electrolyte imbalance or renal function deterioration in certain patients, large-volume paracentesis provides an immediate localized benefit. With ascites primarily resulting from conditions like cirrhosis or heart failure, it is essential to manage this complication without overwhelming the patient's renal function. A large-volume paracentesis can effectively achieve this, making it a preferred option for those who cannot tolerate the side effects of diuretics. While intravenous fluids, dialysis, and transfusions of red blood cells might be indicated in different contexts for various complications or clinical scenarios, they are not targeted specifically for managing ascites in this situation. Thus, large-volume paracentesis stands out as the most appropriate intervention for symptomatic relief in patients who cannot receive diuretics.