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Determining the cause of new onset ascites in patients with serum-ascites albumin gradient (SAAG) ≥1.1 g/dL

Determining the cause of new onset ascites in patients with serum-ascites albumin gradient (SAAG) ≥1.1 g/dL
This figure shows an approach to determining the cause of new onset ascites in patients with SAAG ≥1.1 g/dL. The SAAG is calculated by subtracting the ascitic fluid albumin value (in g/dL) from the serum albumin value (in g/dL). Further evaluation is informed by ascitic fluid tests including total protein concentration and white blood cell count with differential. This figure includes several clinically important etiologies but does not include all possible causes. For additional details, refer to content on evaluating ascites and managing the underlying conditions.

SAAG: serum-ascites albumin gradient; SBP: spontaneous bacterial peritonitis.

* Secondary bacterial peritonitis is less common than SBP and is suspected in patients with bile-stained ascites with elevated fluid total protein, elevated fluid lactate dehydrogenase, and/or low fluid glucose. Imaging may show a perforated viscus or infectious process involving an abdominal organ. The SAAG in secondary bacterial peritonitis is variable. Refer to content on differentiating secondary bacterial peritonitis from SBP for details.

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