Ascites from portal hypertension in the dog with cirrhosis
10-year-old Cocker Spaniel with biopsy-diagnosed chronic hepatitis and cirrhosis. It has moderate ascites (protein-poor transudate) that does not impair breathing. Albumin 2.0 g/dL; no signs of encephalopathy.
What is the most appropriate management of the ascites?
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A. Spironolactone (with low-dose furosemide if needed), moderate sodium restriction and monitoring of electrolytes and renal function
Correct. Portal hypertension causes secondary hyperaldosteronism, which is why spironolactone is the mainstay. Monitor potassium and renal function, and drain only if ascites compromises breathing or does not respond.
B. High-dose furosemide as the only diuretic
It causes hypokalaemia, alkalosis and dehydration, which precipitate hepatic encephalopathy, and does not address the hyperaldosteronism.
C. Complete abdominocentesis whenever fluid builds up
Repeated drainage removes protein and can cause hypovolaemia. It is reserved for tense or refractory ascites.
D. Routine 25% human albumin to correct hypoalbuminaemia
In dogs it can cause severe, even delayed, hypersensitivity reactions, and its effect is transient. It is not a routine treatment for ascites.
lightbulb Key takeaway
Ascites in a dog with chronic hepatitis indicates portal hypertension and a worse prognosis. Portal hypertension also predisposes to gastrointestinal ulceration: consider a gastroprotectant and avoid NSAIDs. Gastrointestinal bleeding can trigger encephalopathy.
References: ACVIM Consensus Statement on the Diagnosis and Treatment of Chronic Hepatitis in Dogs (Webster et al., 2019)
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.