Dawaa Reference

chronic

Ascites

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Ascites - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470482/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DS51.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care

Verified against5 documents
  • No dose - referral pathway, no medicine given in primary care
  • Egyptian National Drug Formulary - Cardiovascular
  • Ascites - disease-level clinical article (ascites-clinical.txt)
  • Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph, edema of hepatic cirrhosis / ascites)
  • Ascites - disease-level clinical article (ascites-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • Progressive abdominal swelling, sometimes painless, sometimes with discomfort [abdominal distension]
  • Weight gain, early fullness with meals, and breathlessness from the fluid buildup [breathlessness · weight gain]
  • Fever, belly tenderness and confusion point toward spontaneous bacterial peritonitis [abdominal tenderness · confusion · fever]
  • Unintentional weight loss suggests a malignant cause of the fluid [weight loss]
  • Breathlessness lying flat, orthopnea and leg swelling point to a cardiac cause [breathlessness · leg swelling · orthopnoea]
  • Diarrhea, fatty stools, malnutrition and night sweats suggest chylous ascites [ascites · diarrhoea · night sweats · steatorrhoea]

Signs — what you find (4)

  • Flank dullness that shifts with position, plus a fluid wave on abdominal exam
  • Cirrhosis stigmata: spider angiomas, palmar erythema, muscle wasting and jaundice [cirrhosis · jaundice · muscle wasting · redness]
  • Raised neck veins and lung congestion point to heart failure as the cause [raised JVP]
  • An umbilical nodule (Sister Mary Joseph nodule) signals a GI, pancreatic or genitourinary cancer [umbilical lump]

Tests (8)

  • Diagnostic paracentesis with fluid analysis is the fastest way to find the cause
  • An ascitic fluid neutrophil count of 250 per mm3 or higher diagnoses spontaneous bacterial peritonitis
  • Serum-ascites albumin gradient predicts portal hypertension with about 97% accuracy
  • SAAG at or above 1.1 g/dL points to portal hypertension causes like cirrhosis or heart failure
  • SAAG below 1.1 g/dL points to non-portal-hypertensive causes such as peritoneal cancer or nephrotic syndrome
  • Serum amylase over 1000 U/L, or more than triple normal, supports a pancreatic cause
  • Ascitic fluid triglycerides above 200 mg/dL confirm chylous ascites
  • Ultrasound is the most sensitive imaging test for finding ascites

If not this — what else fits (11)

  • Cirrhosis with chronic liver failure
  • MASH, an advanced fatty-liver disease with fibrosis
  • Viral hepatitis, types B through E
  • Disease of the bile ducts or gallbladder
  • Hepatic vein thrombosis, ie Budd-Chiari syndrome
  • A dilated, poorly contracting heart muscle
  • Hepatorenal syndrome as an underlying cause
  • Pancreatitis causing pancreatic ascites
  • Protein loss through a diseased bowel
  • Familial Mediterranean Fever as a cause
  • Pregnancy complicated by preeclampsia or HELLP syndrome

SourceStatPearls "Ascites" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Loop diuretic - paired with spironolactone for cirrhotic ascites

MAIN TREATMENT - choose one

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Fluid accumulation in the abdominal cavity, most often from cirrhosis in Egypt given the country's high hepatitis-C and chronic liver disease burden; a GP can start diuretics for a known cirrhotic cause but should refer new-onset or complicated ascites for work-up of the underlying cause. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Fluid accumulation in the abdominal cavity, most often from cirrhosis in Egypt given the country's high hepatitis-C and chronic liver disease burden; a GP can start diuretics for a known cirrhotic cause but should refer new-onset or complicated ascites for work-up of the underlying cause.

Cautions
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - Fever, abdominal tenderness, and confusion in a patient with ascites can signal spontaneous bacterial peritonitis and need urgent evaluation.
  • RED FLAG - Patients with ascites (usually from liver disease) should avoid hepatotoxic medications and OTC drugs that can worsen liver injury - NSAIDs in particular, since they are what a GP might otherwise reach for.
  • RED FLAG - Anyone started on diuretics for ascites needs monitoring of weight, electrolytes, renal function (BUN/creatinine), and urinary sodium.
  • RED FLAG - New-onset ascites without a known cause needs investigation, and signs of hepatic encephalopathy or gastrointestinal bleeding need urgent hospital referral.
2

SPIRONOLACTONE

1st line

Strength100 mg

Formoral.solid

Adult dose and duration

Initial: 100 mg once daily; adjust every 3 to 5 days based on response. Maximum dose: 400 mg once daily.

Paediatric dose

1-3 mg/kg/day [child max 400 mg]

(Children (edema/diuresis): Initial 1 to 3 mg/kg/day divided every 6 to 24 hours; titrate as needed; maximum 4 to 6 mg/kg/day in divided doses every 6 to 12 hours or 400 mg/day, whichever is less.)

Dose by weight
3kg3-9 mg/day
4kg4-12 mg/day
5kg5-15 mg/day
6kg6-18 mg/day
7kg7-21 mg/day
8kg8-24 mg/day
9kg9-27 mg/day
10kg10-30 mg/day
11kg11-33 mg/day
12kg12-36 mg/day
13kg13-39 mg/day
14kg14-42 mg/day
15kg15-45 mg/day
16kg16-48 mg/day
17kg17-51 mg/day
18kg18-54 mg/day
19kg19-57 mg/day
20kg20-60 mg/day
21kg21-63 mg/day
22kg22-66 mg/day
23kg23-69 mg/day
24kg24-72 mg/day
25kg25-75 mg/day
26kg26-78 mg/day
27kg27-81 mg/day
28kg28-84 mg/day
29kg29-87 mg/day
30kg30-90 mg/day
31kg31-93 mg/day
32kg32-96 mg/day
33kg33-99 mg/day
34kg34-102 mg/day
35kg35-105 mg/day
36kg36-108 mg/day
37kg37-111 mg/day
38kg38-114 mg/day
39kg39-117 mg/day
40kg40-120 mg/day
41kg41-123 mg/day
42kg42-126 mg/day
43kg43-129 mg/day
44kg44-132 mg/day
45kg45-135 mg/day
46kg46-138 mg/day
47kg47-141 mg/day
48kg48-144 mg/day
49kg49-147 mg/day
50kg50-150 mg/day
Dose source

Egyptian National Drug Formulary - Cardiovascular

Why

First-line aldosterone antagonist diuretic for managing fluid accumulation in cirrhotic ascites.

Cautions
  • Hyperkalemia.
  • Use with caution in hepatic impairment; minor alterations of fluid and electrolyte balance may precipitate hepatic coma.
  • Any renal disease associated with severe renal impairment (CrCl less than 10 mL/minute) or acute renal failure
Egyptian brands
Egyptian brandManufacturerIndicative price
EPILACTONE 100 MG 10 TABS.EIPICO7.00 EGP (0.70/unit)
SPIRONOLACTONE (DELTA) 100MG 20 TAB.GLOBAL NAPI PHARMACEUTICALS > AL DELTA PHARMACEUTICALS TRADING CO.16.80 EGP (0.84/unit)
POTASAVE 100 MG 20 TABALFACURE PHARMACEUTICALS21.00 EGP (1.05/unit)
ALDACTONE 100MG 20 TABKAHIRA > SEARLE-CANADA22.00 EGP (1.10/unit)
POTASPIRONO 100 MG 20 TAB.UNIPHARMA90.00 EGP (4.50/unit)
SPECTONE 100 MG 20 TABS.KAHIRA90.00 EGP (4.50/unit)

LOOP DIURETIC - PAIRED WITH SPIRONOLACTONE FOR CIRRHOTIC ASCITES

3

FUROSEMIDE

Loop diuretic - paired with spironolactone for cirrhotic ascites

1st line

Strength40 mg

Formoral.solid

Adult dose and duration

20 to 50 mg orally once daily, then titrated to effect. The disease article's cirrhotic-ascites pairing is spironolactone 100 mg with furosemide 40 mg, both once daily, keeping the 100:40 ratio when titrating

Paediatric dose

The ENDF's cirrhotic-ascites dosing is stated for adults; no paediatric figure is given for this indication.

Dose source

Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph, edema of hepatic cirrhosis / ascites)

Why

The disease article's first-line regimen for high-SAAG ascites is sodium restriction plus once-daily spironolactone AND furosemide in a 100:40 ratio. The card carried spironolactone alone, which is half the regimen. The ENDF names cirrhosis with ascites in the furosemide indication itself.

Cautions
  • Hypersensitivity to sulfonamide-derived drugs
  • Anuria; hepatic disease
  • Severe electrolyte depletion until the condition improves or is corrected
Egyptian brands
Egyptian brandManufacturerIndicative price
ODEMENT 40MG 10 TAB.EL NASR1.30 EGP (0.13/unit)
FRUZEX 40MG 12 TAB.MISR3.25 EGP (0.27/unit)
FUROSEMIDE 40MG 20 TAB.SEDICO7.50 EGP (0.38/unit)
FURORETIC 40 MG 30 TABS.DEBEIKY > VETOPHARM14.25 EGP (0.47/unit)
LAFUREX 40MG 20 TAB.AMOUN9.50 EGP (0.47/unit)
SALEX 40 MG 20 TABS.ARAB DRUG COMPANY (ADCO)10.00 EGP (0.50/unit)
FUROSEMIDE-ALEX 40MG 20 TAB.ALEXANDRIA19.00 EGP (0.95/unit)
LASIX 40 MG 24 TABS.SANOFI30.00 EGP (1.25/unit)
GENESEMIDE 20MG/5ML SYRUP 120 ML? strength differs? different route - not oral solidMEDIZEN PHARMACEUTICAL INDUSTRIES > VODACHEM56.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.