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Complications of cirrhosis

  • Admission orders

    • Admit: Floor, ICU if AMS
    • Diagnosis: Complications of cirrhosis
    • Condition: Fair
    • Vital Signs: vitals and neuro checks q 2 hours x 4, then q 4 hours until stable, and then floor protocol
    • Allergies:
    • Nursing:
      • Daily weights
      • Strict I/Os
      • TEDS/SCDs
      • Guaiac stools
      • CIWA protocol for EtOH withdrawal
    • Diet: High-Protein, High-Calorie, Low-Sodium (1500-2000 mg/day)
    • Activity: as tolerated
    • Labs:
      • CBC with platelets q day
      • Chem q day
      • LFTs
      • urinalysis
      • CXR (PA and lateral)
      • paracentesis (therapeutic and diagnostic)
    • IV: None
    • Special:
    • Medications:
      • Spironolactone 50 mg PO qd
      • Furosemide 20 mg PO qd
      • multivitamins 1 tablet PO qd
      • Acetaminophen 325-650 mg PO q 6 hours prn pain or fever. Not to exceed 2 g/day total
      • albumin
        • if removing > 5 L ascitic fluid: 6-10 g IV
        • if SBP: 1.5 g/kg IV at time of dx, then 1g/kg IV 48 hours later
        • if rising creatinine: 1g/kg IV at dx and 20-40 g IV qd x 5-20 days
      • vasoconstrictor if rising creatinine
      • cefotaxime 2 g IV q 8 hours x 5 days empiric tx
      • hep A, B vaccination
      • d/c narcotics or anxiolytics
  • Discharge

    • education: diet, EtOH
    • outpatient liver transplant eval

  • Print | Citations

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