Spironolactone in Diuretic Regimens with Meralluride or Thiazides for Pseudointractable Ascites of Cirrhosis

¹ Cornell University Medical College, Hospital for Joint Diseases and Medical Center; Beth Israel Medical Center, New York, N.Y.

The present communication is based on a study of spironolactone (Aldactone) in 20 patients with advanced cirrhosis and ascites which failed to clear under treatment with a conventional diuretic regimen containing abundant meralluride or thiazide. The addition of spironolactone in large doses reestablished urinary volume sufficiently to clear the effusions completely in most of the patients. The results were indistinguishable from those of similar experiments in advanced pseudointraetable congestive heart failure, described in our previous publication. The mechanism in cirrhotic ascites also appeared similar to that in the heart failure patients. There were the few patients in whom the treatment increased the effusion. There was also the fact that the spironolactone alone often produced a paradoxical dominant reactive antidiuretic effect, and in spite of this effect it enhanced the diuresis from meralluride and thiazide that followed.