[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-442836-105":59,"doc-detail-442836-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","acute-pulmonary-edema-and-cardiac-arrest-after-large-volume-paracentesis-in-a-patient-with-decompensated-cirrhosis","Acute Pulmonary Edema and Cardiac Arrest After Large-Volume Paracentesis in a Patient With Decompensated Cirrhosis","","Large-volume paracentesis is a widely used and generally safe therapy for refractory ascites in cirrhosis, but serious complications remain uncommon. The report describes a woman in her 40s with decompensated alcohol-related cirrhosis who developed acute pulmonary edema and respiratory failure twice following large-volume paracentesis. The second event progressed to cardiac arrest and death despite prolonged intensive care. Proposed mechanisms include re-expansion pulmonary edema and abrupt intra-abdominal pressure–triggered hemodynamic and cardiogenic decompensation, underscoring risk in selected high-prone patients.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/acute-pulmonary-edema-and-cardiac-arrest-after-large-volume-paracentesis-in-a-patient-with-decompensated-cirrhosis/442836/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/acute-pulmonary-edema-and-cardiac-arrest-after-large-volume-paracentesis-in-a-patient-with-decompensated-cirrhosis/442836.png","ImageObject",300,407,{"name":92,"@type":93},"dhado","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What complication occurred after large-volume paracentesis in this patient?","Question",{"text":112,"@type":113},"The patient developed acute pulmonary edema with respiratory failure. In the second episode, this progressed to cardiac arrest and death.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What interventions were performed during the large-volume paracentesis procedures?",{"text":117,"@type":113},"About 14.5 L and later 11 L of ascitic fluid were drained, with albumin replacement using 20% human albumin solution administered during the procedures.",{"name":119,"@type":110,"acceptedAnswer":120},"What mechanisms did the report propose for the deterioration after paracentesis?",{"text":121,"@type":113},"Proposed mechanisms included re-expansion pulmonary edema from chronic lung collapse and cardiopulmonary decompensation driven by hemodynamic instability triggered by abrupt intra-abdominal pressure changes.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},442836,1790765141,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52,"preview_page_count":4},5909893218464,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","ACG CASE REPORTS JOURNAL   \nCASE REPORT | LIVER  \nAcute Pulmonary Edema and Cardiac Arrest After Large-Volume Paracentesis in a Patient With Decompensated Cirrhosis  \nMareen Zachariah, MBChB, MRCP (UK) 1 , Thomas Fleck, MBChB, MRCP (UK) 1 , and Selena Dixon, BSc (Hons), MBChB, MRCP (UK) 1  \n1 Manchester Royal Infirmary Centre for Gastroenterologyand Hepatology, Manchester University NHS Foundation Trust, Manchester, England  \nABSTRACT  \nLarge-volume paracentesis is a well-established and generally safe treatment for refractory ascites in cirrhosis, with serious complications rarely reported. We describe a woman in her 40s with decompensated alcohol-related cirrhosis who developed acute pulmonary edema and respiratory failure on 2 occasions after large-volume paracentesis. The second episode was complicated by cardiac arrest and death despite prolonged intensive care. Proposed mechanisms include re-expansion pulmonary edema from chronic lung collapse, as well as hemodynamic instability and cardiogenic decompensation triggered by abrupt intra-abdominal pressure changes. This case highlights that even routine procedures in cirrhosis may precipitate catastrophic cardiopulmonary complications in select high-risk patients.  \nKEYWORDS: large-volume paracentesis; ascites; decompensated cirrhosis; re-expansion pulmonary edema  \nABBREVIATIONS: HAS, human albumin solution; LVP, large volume paracentesis; RPE, reexpansion pulmonary edema  \nINTRODUCTION  \nLarge-volume paracentesis (LVP) is an established and generally safe therapeutic intervention for managing refractory ascites inpatients with decompensated cirrhosis.1 Minor technical complications occur in approximately 5%–6% ofLVP procedures.2 Major adverse events, such as bleeding, infection, or bowel perforation, are rare and have been reported in approximately 0.3%–2% of cases.2–4 Although adverse event are uncommon, rare cases of life-threatening respiratory and hemodynamic deterioration have been described.5–7 We present a rare case of acute pulmonary edema and cardiac arrest after LVP in a patient with decompensated cirrhosis.  \nCASE REPORT  \nA woman in her 40s with decompensated alcohol-related cirrhosis presented with progressive ascites. She was diagnosed 4 years earlier and managed with diuretics and dietary support. Her history included chronic alcohol use but no prior cardiorespiratory disease. The year before presentation, she was admitted with worsening ascites, hepatorenal syndrome, and underwent 2 uncomplicated LVPs. Despite optimized diuretics, the ascites remained refractory and functionally she was limited.  \nShe presented again for a planned outpatient LVP during which 14.5 L ofascitic fluid was drained over 4 hours and 5 100 mL bottles of 20% human albumin solution (HAS) administered. Mid-procedure, she developed acute respiratory distress with hypoxia, prompting emergency admission.  \nChest radiograph and bedside ultrasound revealed chronic bi-basal atelectasis, bilateral pleural effusions, and pulmonary edema (Figure 1B) . She improved with diuretics. Echocardiography later demonstrated a mildly reduced left ventricular  \nACG Case Rep J 2026;13:e01950 . doi:10 . 14309/crj.0000000000001950. Published online: January 5, 2026 Correspondence: Mareen Zachariah, MBChB, MRCP (UK) ([mareen.zachariah@mft.nhs.uk](mareen.zachariah@mft.nhs.uk)) .  \nACG Case Reports [Journal / Volume 13 acgcasereports.com 1](Journal / Volume 13 acgcasereports.com 1)  \nZachariah et al Acute Pulmonary Edema and Cardiac Arrest  \nFigure 1. Serial chest radiographs: (A) baseline film obtained 5 months before the first LVP of 14.5 L demonstrating chronic bibasilaratelectasis and blunted costophrenic angles consistent with small bilateral pleural effusions (right greater than left); (B) radiograph from the first admission showing pulmonary edema; and (C) postcardiac arrest radiograph demonstrating extensive pulmonary edema.  \nejection fraction (50%), left atrial dilation, and a persistent left pleural","cbCaiqEoP0xhxcuN","https://ap.wps.com/l/cbCaiqEoP0xhxcuN","pdf",484177,"English","# Abstract\n# Introduction\n# Case Report\n## First Admission and Imaging Findings\n## Second Admission: Seizure and Cardiac Arrest\n# Discussion","[{\"question\":\"What complication occurred after large-volume paracentesis in this patient?\",\"answer\":\"The patient developed acute pulmonary edema with respiratory failure. In the second episode, this progressed to cardiac arrest and death.\"},{\"question\":\"What interventions were performed during the large-volume paracentesis procedures?\",\"answer\":\"About 14.5 L and later 11 L of ascitic fluid were drained, with albumin replacement using 20% human albumin solution administered during the procedures.\"},{\"question\":\"What mechanisms did the report propose for the deterioration after paracentesis?\",\"answer\":\"Proposed mechanisms included re-expansion pulmonary edema from chronic lung collapse and cardiopulmonary decompensation driven by hemodynamic instability triggered by abrupt intra-abdominal pressure changes.\"}]","Acute Pulmonary Edema and Cardiac Arrest After Large-Volume Paracentesis in a Patient With Decompensated Cirrhosis | PDF",1790701835]