AARON SPITAL, M.D.
To the editor: In their excellent review of ascites in cirrhosis, Drs. Rocco and Ware (1) recommend spironolactone when diuretic therapy is indicated. This widely accepted practice was recently supported by the results of a controlled study comparing the efficacies of spironolactone and furosemide (2). Nonetheless, I have several concerns with this approach.
First, the use of spironolactone for cirrhotic ascites derives from the concept that hyperaldosteronism plays a major role in the sodium retention of cirrhosis. More recent data have cast doubt on this hypothesis, and it now appears likely that aldosterone is not the primary cause of impaired
SPITAL A. Ascites in Cirrhosis. Ann Intern Med. ;106:169–170. doi: 10.7326/0003-4819-106-1-169_2
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Published: Ann Intern Med. 1987;106(1):169-170.
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