Mark T., a 54-year-old male with a history of chronic alcohol use and liver cirrhosis, presents to the clinic with worsening abdominal swelling and bilateral lower limb edema over the past two weeks. He also reports mild shortness of breath and reduced urine output despite being on diuretics, including spironolactone and furosemide, for the past month. Mark denies any fever, chest pain, or gastrointestinal bleeding. Mark’s medical history includes liver cirrhosis, diagnosed two years ago due to chronic alcohol use. His ascites has previously been managed with diuretics and occasional paracentesis. He stopped consuming alcohol six months ago and has no other significant health issues. On examination, Mark’s vital signs reveal mild hypotension with a blood pressure of 100/65 mmHg and a heart rate of 92 bpm. Abdominal examination shows gross ascites with a positive fluid wave, and pitting edema extends to the mid-thighs bilaterally. Signs of chronic liver disease, such as jaundice and spider angiomas, are also noted. Laboratory findings reveal significant hypoalbuminemia with a serum albumin level of 2.1 g/dL (normal: 3.5–5 g/dL). Total bilirubin is elevated at 3.5 mg/dL, and his INR is prolonged at 1.8, consistent with synthetic liver dysfunction. Renal function is mildly impaired with a creatinine level of 1.3 mg/dL, and serum sodium is 129 mEq/L. Mark’s urine output has decreased to 500 mL/day despite diuretic therapy. How does low serum albumin in chronic liver cirrhosis impair diuretic response?
