In patients who do not respond
to aldosterone antagonists, which means a
reduction of body weight of less than 2kg per
week, or if the patient develops hyperkalaemia
or recurrent ascites, a loop diuretic such as
furosemide should be added to the treatment
regimen at a dose of 40-160mg daily (Runyon
2013). Patients should be monitored frequently
for clinical and biochemical parameters,
particularly during the first month of treatment.
Side effects of diuretics include renal failure,
hepatic encephalopathy, electrolyte disorders,
gynaecomastia and muscle cramps (British
National Formulary 2013). Monitoring should,
therefore, include electrolyte balance, renal
function and assessment for signs of hepatic
encephalopathy