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Spontaneous bacterial peritonitis with renal dysfunction — SCE Acute Medicine MCQ

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HardGastroenterology and hepatologySpontaneous bacterial peritonitis with renal dysfunctionSCE Acute Medicine

A 64-year-old man with cirrhosis and tense ascites is admitted with fever, abdominal pain and worsening renal function. Diagnostic ascitic tap shows neutrophils 0.68 x 10^9/L; Gram stain is negative. Blood pressure is 102/64 mmHg and serum creatinine is 178 micromol/L. What is the most appropriate next step in management?

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Reveal the answer and explanation

Correct answer: B — Give intravenous cefotaxime or local equivalent and human albumin

Ascitic neutrophils above 0.25 x 10^9/L diagnose spontaneous bacterial peritonitis even if Gram stain is negative, and prompt intravenous antibiotics are needed. Albumin reduces renal failure and mortality in higher-risk SBP. Prophylaxis is used after treatment, not as sole therapy for established SBP.

Reference: BSG/BASL ascites in cirrhosis guideline; NICE CKS cirrhosis