Thématique :
- Foie
Originalité :
Très original
Solidité :
Doit faire évoluer notre pratique :
Dans certains cas
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
Journal of Hepatology
  2015 Nov;63(5):1126-32  
  doi: 10.1016/j.jhep.2015.06.019  
  Safety, complications and outcome of large volume paracentesis with or without albumin therapy in children with severe ascites due to liver disease  
  Sen Sarma M, Yachha SK, Bhatia V, Srivastava A, Poddar U  


There are currently no published data on post-paracentesis circulatory dysfunction (PPCD) or its prevention in children. Our study was aimed to analyze the safety and complications of large volume paracentesis (LVP) in children with severe ascites due to chronic liver disease with or without albumin therapy.


A prospective longitudinal observational study enrolled children with severe ascites who underwent single time LVP at admission. They were divided into albumin infused (AI) and albumin non-infused (ANI) groups. Hemodynamic monitoring and laboratory parameters including plasma renin activity (PRA) were compared between baseline, 48h and day 6 of LVP. Their outcome at 3months and maximal follow-up were noted.


32 children (AI, n=17; ANI, n=15) had comparable baseline characteristics and 90.6% had high PRA at onset. The incidence of PPCD was 37.5% (ANI: 67%; AI: 12%, p=0.003), occurred if ascitic fluid extraction was >197.5ml/kg (sensitivity: 90%; specificity: 50%, p=0.01) and if flow rate was higher in ANI group (1224±476 vs. 678±214ml/h, p=0.009). ANI patients were susceptible to asymptomatic, persistent hyponatremia (baseline vs. day 6, 131±4 vs. 128±6mEq/L; p=0.04) and had higher rates of recurrent ascites (42%) and hospital readmission (67%) within 3months. No survival benefit among the AI or non-PPCD groups was demonstrated.


LVP is safe in all age groups, best performed under albumin cover to overcome the problems of PPCD and hyponatremia. It is prudent to restrict volume extraction to less than 200ml/kg actual dry weight for all and flow rate of 680ml/h in ANI.

Question posée
Sécurité et complications des paracentèses chez les enfants avec ascite.
Question posée
Voir commentaire.

Cette étude prospective évalue la sécurité et les complications des paracentèses chez un nombre limité (n=32) d’enfants mérite toutefois notre attention compte tenu de la rareté des données concernant le sujet abordé.