Spontaneous Bacterial Peritonitis Evaluation and Management

This video reviews current evidence around the evaluation and management of SBP in patients presenting to the emergency department. Key takeaways include:

  1. Consider SBP in all patients in the ED with ascites
  2. Abdominal pain or tenderness is the most sensitive finding for SBP
  3. Contrastingly the presence of fever has low sensitivity for SBP. Hypothermia is normal in patients with advanced cirrhosis so lower your fever threshold to 37.8 C in this population. Marked hypothermia is specific for SBP and carries a poor prognosis.
  4. 50% of patients will have some level of altered mental status but it may be subtle, try to get collateral
  5. ANC over 250 on paracentesis is diagnostic for SBP
  6. Consider CT abdomen in patients with localized abdominal tenderness, that are critically ill, or are in severe pain
  7. Consider use of POCUS to guide paracentesis
  8. Give IV albumin at a dose of 1.5g/kg once SBP is confirmed
  9. In most areas the first line antibiotic choice will be a 3rd generation cephalosporin, however there are rising cases of multi-drug resistant bacterial infections. If they have risk factors consider expanding coverage with pip-tazo or a carbapenum. If they have risk factors for MRSA given vancomycin or linezolid.

More EM Quick Hits Videos

Please donate to EM Cases to help ensure continued high quality free open access EM education. https://emergencymedicinecases.com/donation