Spironolactone vs Furosemide in ascites patient (UPDATED)

Few reasons why spironolactone are preferred in case of chronic liver disease than frusemide:

1. Spironolactone is more suitable in ascites patient as compare to furosemide

because it's effect is milder, diuretics tends to decrease the intravascular volume

when patient standing up the shifting of fluid from intra-peritoneal back to intravascular is slower

thus a milder form of diuretics is chosen to prevent postural hypotension.

2. Spironolactone acts on aldosterone receptors --> inhibiting the aldosterone effects-->decrease Na and water absorption into intravascular space--> decrease water shift into third space ( peritoneal cavity)

3. Frusemide is not potassium sparing--> hypokalemia ( known risk to precipitate hepatic encephalopathy)