Lactulose, Rifaximin (add after a second episode), Spironolactone ± Furosemide (ascites; salt under 5 g/day), Carvedilol (varices), Cefotaxime (SBP: ascitic neutrophils 250/µL or more), Albumin 20% (with SBP antibiotics), Norfloxacin (SBP prophylaxis), Tenofovir (hepatitis B), Entecavir (hepatitis B)
Investigations
First visit
CBC, LFT, PT/INR, creatinine, electrolytes — Child-Pugh and MELD scoring.
USG abdomen with Doppler — Ascites, liver texture, portal vein and liver tumour.
HBsAg, anti-HCV — Cause.
Only if indicated
Diagnostic ascitic tap: cell count, albumin, culture — Every new ascites, fever, pain or worsening encephalopathy (SBP).
Blood glucose, blood and urine culture — Encephalopathy — look for the trigger (infection, bleeding, constipation, low sodium).
Upper GI endoscopy — Variceal screening at diagnosis unless on carvedilol.
Follow-up and monitoring
USG and AFP every 6 months — Liver cancer surveillance.
Sodium, potassium, creatinine — Within 1–2 weeks of starting or changing diuretics.
Locked
The adult dose for each drug
Indian brand names for each drug, with a link to buy
ICU Decoded — original critical-care and internal-medicine pathways by
Dr Javed Akhtar, each cited to a current guideline. For education and quick
reference; verify every dose against local protocols before prescribing.