What can happen when ascites is no longer treated?

[Busjedwa]

My Dad is at the very end stages of liver cirrhosis.  He has been being drained as a result of ascites for months now but has been too weak to go in this time.  He is not eating and barely drinking and the fluid has built up over the last few weeks.  He does not want to go into hospital and has told the doctor he wants nature to take its cause now.  How could he die?  Fall into a coma, or could he experience a painful death?  He wants to be at home, but he is comfortable for now.  Could this be the wrong thing at the very end?

[HectorSF]

When ascites get to the point when regular, periodic paracentesis needs to be performed it is called “refactory ascites”. “Refractory ascites” refers to fluid build up in the abdomen that is not responding to medical treatment. Ascites that can no longer be controlled with diet and diuretics. Many of us liver transplant patients had refectory ascites before our transplants when our liver disease became very bad and we were extremely ill.

How could he die?  There are many ways to die from complications of End-Stage Liver Disease. Infections, going into an HE coma, kidney failure and many, many more. No one can predict what will happen or when.

Personally I would advise contacting a hospice organization. They are the professionals. Having a loved one die at home can be more than most people can handle unless you have cared for other dying people before. Hospice can help your father die the way he wants to die. A very important thing when there is little else the person has control over.

Pain meds, DNR (Do Not Resuscitate order), POST, and many other end of life issues is what hospice does. End of life issues are complex and are best managed by folks who do this every day.

Many people who die from End-Stage Liver Disease experience horrible suffering at some point in the process that only hospice personal can manage. It is also good to at least have hospice as a backup plan even if everything seems to be going “naturally” for the time being.

I am sorry to hear that your father appears to be at the end of his life.
My best wishes to you and your family.

Hector

[Busjedwa]

Thanks both for your replies.  I've find the information helpful.  How long can he survive without food?  He hasn't eaten for days, is so weak he can't sit up without help.  He is just skin and bone now, so amaciated.  

[HectorSF]

It is often the case that people, as they get close to the end of life lose interest in their surroundings including in food and drink.

At the end of life people may not feel hunger, but they won't stave over a few days. But if they are not taking fluids they may become drowsy from lack of hydration. As the dehydration progresses, patients become sleepier then slip into a coma before death. This is how people have been dying this way for for thousands of years.

You may want to look at the MedHelp's "Hospice Community" forum to learn more about end-of life issues.

Take care.
Hector

[hepcandme]

I can't presume to recommend whether this the decision is right or wrong but it sounds as if your Dad has made his decision clear

We can never know the exactly how a person will die either but, hopefully, he will have peaceful transition

Be there with him and continue to show your love and support

Keeping you in my thoughts. I know what a difficult time this is for you and your family