S5934 Paracentesis-Induced Circulatory Dysfunction Leading to Motor Vehicle Accident: The Case for an Individualized Approach for Albumin Administration

Introduction: Albumin administration following large volume paracentesis is routinely performed to prevent paracentesis-induced circulatory dysfunction. There is consensus on the benefits of albumin administration, however, there is variation in the recommended cutoff of the volume of fluid removed requiring albumin administration. While it is often recommended that albumin be administered after 5 L of fluid removal, we present a case of a patient with paracentesis-induced circulatory dysfunction leading to a motor vehicle accident after 4.7 L of fluid were removed during a paracentesis. Case Description/Methods: The patient is a 72-year-old woman with a history of liver cirrhosis secondary to metabolic-associated steatohepatitis who presented as a trauma code following a motor vehicle accident. She had a syncopal episode and found herself in a ditch on the drive home following a routine paracentesis in which 4.7 L of fluid were removed, without administration of albumin. She routinely has had paracenteses in which 8-9 L of fluid were removed without previous complications. On physical examination, there were numerous skin abrasions, lacerations, and significant abdominal distention. Computed tomography (CT) abdomen and pelvis showed an acute compression fracture of the lumbar spine and evidence of moderate to severe abdominal ascites. Patient was found to have hypoalbuminemia at 2.79 g/dL, which was replenished. A syncopal workup was performed including EKG, echocardiogram, CT head, and carotid ultrasound which were all unremarkable. The syncopal episode leading to the motor vehicle accident was attributed to paracentesis-induced circulatory dysfunction due to lack of albumin administration. Discussion: There is not a full consensus regarding the indications for albumin administration following paracentesis. However, albumin administration is generally recommended for large-volume paracentesis with greater than 5 L of fluid removed. However, patients may still present with paracentesis-induced circulatory dysfunction when less than 5 L are removed. The need for albumin should be adjusted based on factors including body habitus, renal dysfunction, and hypoalbuminemia. This can prevent adverse events following paracentesis while also avoiding unnecessary and futile administration of albumin. Individualized patient assessment is crucial in deciding albumin administration to prevent the use of albumin in unnecessary or futile instances, while also optimizing patient outcomes and preventing adverse events following paracentesis.