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PPCD: A complication in cirrhosis from large-volume paracentesis, causing renal stress, preventable with albumin.

  • Writer: Mayta
    Mayta
  • Jan 19, 2024
  • 1 min read

Updated: Jan 23, 2024

PPCD in cirrhotic patients, marked by increased plasma renin activity and RAAS activation after removing over 5 liters of ascitic fluid, leads to renal vasoconstriction and can be prevented with albumin infusion.

Question: Why is the risk of Post-Paracentesis Circulatory Dysfunction (PPCD) a concern in large-volume paracentesis procedures in patients with cirrhosis?

In PPCD, removing large volumes of over 5 liters of ascitic fluid triggers RAAS overactivity, leading to fluid retention and potential kidney strain and hypertension.

There is no single universally accepted set of criteria, the following framework can be useful in identifying and diagnosing PPCD PPCD Uniqcret's Criteria: First, Exclusion of Other Causes. Rule out other potential causes of the symptoms, such as cardiac events, bleeding, or infection.


Clinical Features

Laboratory Features

Additional Considerations


RAAS overactivity in PPCD PPCD in cirrhosis, caused by removing large volumes of sodium-rich ascitic fluid, can excessively activate the RAAS system. This overactivity leads to increased aldosterone release, causing the kidneys to reabsorb more water and sodium. The resulting fluid retention can strain the kidneys, possibly leading to renal dysfunction and hypertension.

How albumin administration combats Post-Paracentesis Circulatory Dysfunction (PPCD)

Effect on Hormones

Reducing RAAS Overactivity

Effect on Vessels

Enhancing Blood Vessel Tone

Decrease Endothelial permeability

Effect on Serum osmolality

Boosting Oncotic Pressure

All of these work together and it result is

Volume Expansion and Blood Pressure Stabilization

Improving Splanchnic Circulation

Supporting Kidney Function

Miscellaneous benefits



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Message for International Readers
Understanding My Medical Context in Thailand

By Uniqcret, M.D.
 

Dear readers,
 

My name is Uniqcret, which is my pen name used in all my medical writings. I am a Doctor of Medicine trained and currently practicing in Thailand, a developing country in Southeast Asia.
 

The medical training environment in Thailand is vastly different from that of Western countries. Our education system heavily emphasizes rote memorization—those who excel are often seen as "walking encyclopedias." Unfortunately, those who question, critically analyze, or solve problems efficiently may sometimes be overlooked, despite having exceptional clinical thinking skills.
 

One key difference is in patient access. In Thailand, patients can walk directly into tertiary care centers without going through a referral system or primary care gatekeeping. This creates an intense clinical workload for doctors and trainees alike. From the age of 20, I was already seeing real patients, performing procedures, and assisting in operations—not in simulations, but in live clinical situations. Long work hours, sometimes exceeding 48 hours without sleep, are considered normal for young doctors here.
 

Many of the insights I share are based on first-hand experiences, feedback from attending physicians, and real clinical practice. In our culture, teaching often involves intense feedback—what we call "โดนซอย" (being sliced). While this may seem harsh, it pushes us to grow stronger, think faster, and become more capable under pressure. You could say our motto is “no pain, no gain.”
 

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I believe that my knowledge—built from real clinical experience in a high-intensity, under-resourced healthcare system—can offer valuable perspectives that are hard to find in textbooks. Whether you're a student, clinician, or educator, I hope my content adds insight and value to your journey.
 

With respect and solidarity,

Uniqcret, M.D.

Physician | Educator | Writer
Thailand

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