Podcast 676: Spontaneous Bacterial Peritonitis

<p><strong>Contributor:  Sam Killian, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Patients with cirrhosis and ascites are frequently evaluated for spontaneous bacterial peritonitis, an infection of the ascites fluid that is not from a surgically treated source</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Fever, abdominal pain, and altered mental status should all raise clinical suspicion in a patient with ascites</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Fluid from paracentesis may show increased WBCS (polys and neutrophils), high LDH, high amylase, and decreased glucose</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Outcomes are very poor in these patients with 30-40% of these patients continue to renal failure with 60-80% in-hospital mortality</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Typically treat with a third generation cephalosporin or ampicillin+gentamicin</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Long B, Koyfman A. The emergency medicine evaluation and management of the patient with cirrhosis. Am J Emerg Med. 2018;36(4):689-698. doi:10.1016/j.ajem.2017.12.047</span></p> <p><span style="font-weight: 400;">MacIntosh T. Emergency Management of Spontaneous Bacterial Peritonitis - A Clinical Review. Cureus. 2018;10(3):e2253. Published 2018 Mar 1. doi:10.7759/cureus.2253</span></p> <p><em><span style="font-weight: 400;">Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD</span></em></p> <p> </p> <p><span style="font-weight: 400;">The Emergency Medical Minute is excited to announce that we are now offering</span> <em><span style="font-weight: 400;">AMA PRA Category 1 credits™</span></em> <span style="font-weight: 400;">via online course modules. To access these and for more in