Fluid overload that is unresponsive to sodium-restricted diet and high-dose diuretic treatment (400 mg/day of spironolactone and 160 mg/day furosemide), or recurs rapidly after therapeutic paracentesis.

Serial therapeutic paracentesis may be performed in patients with refractory ascites.
Post-paracentesis albumin infusion may not be necessary for a single paracentesis of less than 4 to 5 L. For large-volume paracentesis, an albumin infusion of 8 to 10 g per liter of fluid removed can be considered.

Repeated paracentesis may also contribute to fluid volume depletion and protein loss, however, the symptomatic relief gained from this procedure may outweigh the risk of these potential problems.

Bruce A. Runyon. Management of adult patients with ascites due to cirrhosis. Practice Guideline. American Association for the Study of Liver Diseases (AASLD). Hepatology 2004; 39:1-16.