Pushing the limits of Conventional Therapy to Improve Outcomes Slow Continuous Low-dose Knfusion of Furosemide, Albumin and Terlipressin (SCALFI T) for Large Ascites in ACLF

• Treatment of ascites is based on its grading. For grade-1 ascites, no treatment is required, for grade-2, a sodium-restricted diet and diuretics should be recommended; and for grade-3, large volume paracentesis (LVP) followed by sodium-restricted diet (SRD) and diuretics should be prescribed.
• SCALFI T. is a response-guided regimen and is recommended for large ascites in acute-on-chronic liver failure (ACLF).
• Furosemide is > 95% albumin-bound, is filtered across glomerulus, and facilitates active secretion into the S2 segment of PCT by OAT-1 (> 90%).
• Using SCALFI T. facilitates safe and complete mobilization of large ascites. It can be even used in advances liver failure including ACLF, despite some contraindications.
• It is beneficial in reversing two pathophysiological mechanisms – increased intestinal permeability (IIP) and disturbed hemodynamics in crucial vascular beds (systemic, renal or splanchnic).