A 56-year-old man is brought to the emergency department by his daughter due to increasing confusion and abdominal swelling over the past 3 days. He has a history of alcohol use disorder. His temperature is 37.9°C (100.2°F), blood pressure is 105/65 mm Hg, and pulse is 98/min. Physical examination reveals scleral icterus, spider angiomas on the chest, a distended abdomen with a positive fluid wave, and bilateral pitting pedal edema. When the patient extends his arms and dorsiflexes his wrists, a flapping tremor is observed.
Laboratory studies show:
| Test | Result | Reference Range |
|---|---|---|
| Serum sodium | 132 mEq/L | 136-145 mEq/L |
| Serum creatinine | 1.4 mg/dL | 0.7-1.3 mg/dL |
| Serum albumin | 2.7 g/dL | 3.5-5.0 g/dL |
| Total bilirubin | 3.8 mg/dL | 0.1-1.2 mg/dL |
| Aspartate aminotransferase (AST) | 145 U/L | 10-40 U/L |
| Alanine aminotransferase (ALT) | 62 U/L | 7-56 U/L |
| Serum lactate dehydrogenase (LDH) | 300 U/L | 100-250 U/L |
| Serum glucose | 95 mg/dL | 70-99 mg/dL |
A diagnostic paracentesis is performed, yielding cloudy yellow fluid. Ascitic fluid analysis reveals:
| Test | Result |
|---|---|
| Total protein | 0.9 g/dL |
| Albumin | 1.1 g/dL |
| Lactate dehydrogenase (LDH) | 110 U/L |
| Glucose | 85 mg/dL |
| White blood cell count | 400/mm³ |
| Neutrophils | 75% |
| Lymphocytes | 25% |
| Red blood cell count | 100/mm³ |
Based on these laboratory results, which of the following is the most accurate diagnostic interpretation?
- Spontaneous bacterial peritonitisAnswer
- BUncomplicated cirrhotic ascites
- CSecondary bacterial peritonitis
- DAscites secondary to right-sided heart failure
- EMalignant peritoneal carcinomatosis