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©2013 UpToDate ® Print Email Treatments for hepatic hydrothorax All patients with confirmed hepatic hydrothorax should be referred for evaluation for liver transplantation. The first step in management is therapy with low sodium diet (70-90 meq/day) and diuretics (see topic review on diuretic therapy for ascites). If there is no response to diuretics, therapeutic thoracentesis of approximately 2 liters can be attempted followed by diuretics at lower doses if possible. If patients do not respond to diuretics or develop complications they can be considered to have hepatic hydrothorax and should be considered for TIPS placement. This measure may help as a bridge to liver transplantation. However, patients should be carefully selected. TIPS is best considered in patients younger than 60 years of age, without hepatic encephalopathy and/or those with Child A/B cirrhosis For patients that cannot undergo TIPS placement, consideration for pleurodesis or diaphragmatic repair by thoracoscopy should be considered. Chest tube placement should be avoided, as it is associated with severe complications. * Furosemide 40 mg/day and spironolactone 100mg/day and if there is no response, diuretics may be increased in a stepwise fashion every 3-5 days by doubling doses (ratio of 40mg:100mg), furosemide up to 160 mg/day and spironolactone up to 400 mg/day.