Background Paracentesis for management of ascites is frequently performed in hospices. Serum-ascites albumin gradient (SAAG) should be measured to guide management. Patients with ascites caused by portal hypertension have a SAAG 11 g/L. Usual management is to:

• give human albumin solution (HAS) for renal-protective effects

• prescribe spironolactone to reduce re-accumulation of ascites

This practice is established in the management of portal hypertension due to cirrhosis. However, the incidence of portal hypertension in patients requiring paracentesis for malignant ascites is unknown.

Methods In 2019 guidelines were written to ensure SAAG was checked for patients admitted to the hospice for paracentesis. These guidelines were audited in 2020. The audit covered an 11-month period, looking at whether SAAG was available pre-procedure, and whether HAS and spironolactone were given.

Results 25 drains were inserted in 12 different patients. 100% of these patients had SAAG calculated.

67% (n=8) received HAS. 50% of this group (n=4) had a diagnosis of cirrhosis, and 50% (n=4) had metastatic malignancy. 3 of the patients given HAS were already on spironolactone, 3 were started on it post procedure (these were patients with malignant ascites), and 1 had their dose increased.

4 patients with malignant ascites received HAS and 3 were started on spironolactone.

Conclusions Measuring SAAG demonstrated cases of malignant ascites associated with portal hypertension. This led to a change in management with increased use of HAS and spironolactone in patients with malignant ascites. All patients undergoing abdominal paracentesis should have SAAG recorded and used to determine appropriate use of HAS and spironolactone.