A 72-year-old man presents to your clinic with worsening lower leg edema.

This patient has signs suggestive of decompensated liver cirrhosis (ascites, peripheral edema, low-normal BP, alcohol use, abdominal distension). Sodium restriction is the cornerstone of first-line management to prevent fluid retention in cirrhotic ascites.

Toronto Notes 2023 – Gastroenterology, “Cirrhosis and Ascites” Section:

“Sodium restriction (<2 g/day) is the most important non-pharmacologic management for ascites. Fluid restriction is added only in cases of severe hyponatremia.”

MCCQE1 Objectives (Internal Medicine > 76-5: Liver Disease):

“Candidates must manage ascites conservatively using sodium restriction, with diuretics added as needed.”

Lactulose (E) is used for hepatic encephalopathy, not ascites. Ramipril (B) may worsen renal function in cirrhosis. Nadolol (C) is used for variceal bleeding prophylaxis. Compression stockings (D) are not helpful in ascites-related edema.

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