How much is too much? Pushing the limits of fluid removal via paracentesis

Peritoneal fluid accumulation can be caused by a multitude of factors. Patients with chronic cirrhosis can suffer from recurrent ascites requiring repeat paracentesis for fluid removal and symptom control. A paracentesis is a commonly performed procedure with a low risk profile that can be performed at the bedside by appropriately trained individuals. A large volume paracentesis is often therapeutic and focus should be placed on removing as much fluid as safely tolerated. We present a 57-year old Caucasian male with worsening abdominal distention and recurrent ascites who presented for progressive shortness of breath. Given the large volume of ascites noted, the patient underwent a passive bedside paracentesis with 29 L removed. The patient tolerated the 5-h procedure well without any post-procedure complications, challenging the extent of volume removal during bedside paracentesis.