Cost-effective methods of treating ascites.

In patients with a 24-hour urinary sodium excretion of less than 80 mEq (80 mmol), prompt diuretic therapy is recommended. Not all patients will require therapeutic paracentesis, but in those who are symptomatic, removal of 4 to 6 L of ascitic fluid should not be unnecessarily delayed. Urinary sodium monitoring is a simple, accurate and effective method of directing therapy, particularly when patients do not readily respond to diuretics or when they have recurrent ascites as outpatients.