Development of ascites in children with chronic liver disease is the most common form of decompensation. It is associated with a poor prognosis and increased risk of mortality. A diagnostic paracentesis should be performed in liver disease patients with- new-onset ascites, at the beginning of each hospital admission and when ascitic fluid infection (AFI) is suspected. The routine analysis includes cell count with differential, bacterial culture, ascitic fluid total protein and albumin. A serum albumin-ascitic fluid albumin gradient of ≥1.1 g/dL confirms the diagnosis of portal hypertension. Ascites has been reported in children with non-cirrhotic liver disease like acute viral hepatitis, acute liver failure and extrahepatic portal venous obstruction. The main steps in management of cirrhotic ascites include dietary sodium restriction, diuretics and large-volume paracentesis. Sodium should be restricted to maximum of 2 mEq/kg/d (max 90 mEq/d) of sodium/day. Oral diuretic therapy comprises of aldosterone antagonists (e.g., spironolactone) with or without loop-diuretics (e.g., furosemide). Once the ascites is mobilized, the diuretics should be gradually tapered to the minimum effective dosage. Tense ascites should be managed with a large-volume paracentesis (LVP) preferably with albumin infusion. Therapeutic options for refractory ascites include recurrent LVP, transjugular intrahepatic porto-systemic shunt and liver transplantation. AFI (fluid neutrophil count ≥250/mm³) is an important complication, and requires prompt antibiotic therapy. Hyponatremia, acute kidney injury, hepatic hydrothorax and hernias are the other complications.

慢性肝病儿童出现腹水是最常见的失代偿形式。它与预后不良和死亡风险增加有关。对于新发腹水的肝病患者，应在每次入院之初以及怀疑腹水感染（AFI）时进行诊断性腹腔穿刺术。常规分析包括分类细胞计数、细菌培养、腹水总蛋白和白蛋白。血清白蛋白-腹水白蛋白梯度≥1.1 g/dL可确诊门脉高压。据报道，患有非肝硬化性肝病（如急性病毒性肝炎、急性肝功能衰竭和肝外门静脉阻塞）的儿童会出现腹水。治疗肝硬化腹水的主要步骤包括饮食限制钠、利尿剂和大容量腹腔穿刺术。钠摄入量应限制在每天最多 2 mEq/kg/d（最多 90 mEq/d）。口服利尿剂治疗包括醛固酮拮抗剂(例如螺内酯)联合或不联合袢利尿剂(例如速尿)。一旦腹水流动，利尿剂应逐渐减量至最低有效剂量。紧张性腹水应通过大量腹腔穿刺术（LVP）进行处理，最好是输注白蛋白。难治性腹水的治疗选择包括复发性 LVP、经颈静脉肝内门体分流术和肝移植。 AFI（体液中性粒细胞计数≥250/mm ³ ）是一种重要的并发症，需要及时进行抗生素治疗。其他并发症包括低钠血症、急性肾损伤、肝性胸水和疝气。