BRIEF REPORTS Comparative Utility of Sero Ascites Albumin Gradient and Ascitic Fluid Total Protein for Differential Diagnosis of Ascites Bibhuti Das Usha Acharya Alok Purohit Ascites can be defined as the abnormal accumulation of fluid inside the peritoneal cavity. Earlier ascites was classified as transudative and exudative based on the total protein concentration of the ascitic fluid. The traditional concept of high pro- tein ascites(> 2.5 g/dl) as exudate was questioned because: (a) the normal perito- neal fluid protein concentration is some times > 4 g/dl(1); (b) the ascitic fluid pro- tein concentration increases in cirrhotic patients with diuresis and albumin infu- sion^); (c) some transudative ascites like cardiac ascites have high protein concentra- tion while some traditionally exudative ascites like malignant ascites have low con- centration of protein(3); and (d) moreover cirrhosis may be the most frequent cause of high protein ascites(4). To overcome the shortcomings ascites is now being classified as "high gradient" and "low gradient"(5). When the difference between serum albumin and ascitic fluid albumin is > l.lg/dl it is called high gradi- ent ascites, whereas if the difference is < 1.1 g/dl it is termed as low gradient ascites(6). From the Department of Pediatrics, SPMCHI, SMS Medical College, Jaipur 302 004. Reprint requests: Dr. Alok Purohit, S-7, Vivekanad Marg, C-Scheme, Jaipur 302 001. Manuscript received; ]une 19,1996; Initial review completed: August 26 1996; Revision accepted: January 21,1998 It should be emphasized that Sero Ascites Albumin Gradient (SAAG) is not a ratio but a substraction. The SAAG is based on oncotic hydrostatic balance. Portal hypertension results in an abnormally high hydrostatic pressure gradient between the portal bed and the ascitic fluid. There must be a similarly large difference between ascitic fluid and intravascular oncotic pressure than other proteins. The difference between serum and ascitic fluid albumin concentration correlates directly with portal pressure(7). The present study was designed to com- pare the utility of SAAG and Ascitic Fluid Total Protein (AFTP) for the differential diagnosis of ascites. Subjects and Methods This study comprised of 40 -children with ascites between 0 to 12 years age group (70% male and 30% female) whose diagnoses were established by physical and ultrasound examination. They were admit- ted to SPMCHI, SMS Medical College, Jaipur between July 1994 and December 1995. Before any therapeutic intervention, diagnostic paracentesis of abdomen was done. The samples of ascitic fluid and venous blood samples were obtained in the same sitting. These were analyzed for cell count, pH, specific gravity, cytology, total protein, albumin, cholesterol, LDH and cultures. Specific investigations like liver biopsy, upper gastrointestinal endoscopy, lipid profile and adenosine deaminase level were done wherever indicated, to diagnose the specific etiology of ascites. The diagno- sis of chronic liver disease (CLD) was done by clinical, ultrasonography (USG) abdo- men, liver function tests, liver biopsy and upper gastrointestinal endoscopy(8,9). The established criteria were followed for diag- nosis of nephrotic syndrome (NS) related, ascites. All 26 cases of CLD were biopsy 542