<unk>  results supporting a diagnosis of SBP:
Absolute neutrophil count (PMNs) ≥250, pH <7.35, OR blood-ascites pH gradient >0.1
Bacteria on gram stain (single type)
SAAG > 1.1
Diagnostic of portal hypertension with 97% accuracy
SBP rarely develops in patients without portal hypertension
Protein < 1, Glucose > 50 (otherwise concern for secondary bacterial peritonitis)
Absolute neutrophil count (PMNs) ≥250, pH <7.35, OR blood-ascites pH gradient >0.1
Bacteria on gram stain (single type)
SAAG > 1.1
Diagnostic of portal hypertension with 97% accuracy
SBP rarely develops in patients without portal hypertension
Protein < 1, Glucose > 50 (otherwise concern for secondary bacterial peritonitis)
Diagnostic of portal hypertension with 97% accuracy
SBP rarely develops in patients without portal hypertension
For bloody tap, subtract 1 WBC for every 250 RBC
See  Peritoneal dialysis-associated peritonitis
Cell count >100/mm with >50% neutrophils most consistent with infection
Importance of distinction
Mortality of secondary bacterial peritonitis (eg. perforated appendicitis, cholecystitis) ~100% if treatment is only antibiotics without surgery
Mortality of unnecessary surgery in patients with SBP ~80%
Laboratory findings
Secondary bacterial peritonitis strongly suggested by:
Neutrocytic fluid (PMN ≥250) with two or more of the following:
Total protein concentration >1 g/dL (10 g/L)
Glucose concentration <50 mg/dL (2.8 mmol/L)
LDH greater than upper limit of normal for serum
Ascitic alk phos >240
Gram stain
Large numbers of different bacterial forms
Imaging
If evidence of secondary bacterial peritonitis obtain abdominal imaging
If no evidence of free air or contrast extravasation then surgery is not indicated
Mortality of secondary bacterial peritonitis (eg. perforated appendicitis, cholecystitis) ~100% if treatment is only antibiotics without surgery
Mortality of unnecessary surgery in patients with SBP ~80%
Secondary bacterial peritonitis strongly suggested by:
Neutrocytic fluid (PMN ≥250) with two or more of the following:
Total protein concentration >1 g/dL (10 g/L)
Glucose concentration <50 mg/dL (2.8 mmol/L)
LDH greater than upper limit of normal for serum
Ascitic alk phos >240
Gram stain
Large numbers of different bacterial forms
Neutrocytic fluid (PMN ≥250) with two or more of the following:
Total protein concentration >1 g/dL (10 g/L)
Glucose concentration <50 mg/dL (2.8 mmol/L)
LDH greater than upper limit of normal for serum
Ascitic alk phos >240
Gram stain
Large numbers of different bacterial forms
Total protein concentration >1 g/dL (10 g/L)
Glucose concentration <50 mg/dL (2.8 mmol/L)
LDH greater than upper limit of normal for serum
Large numbers of different bacterial forms
If evidence of secondary bacterial peritonitis obtain abdominal imaging
If no evidence of free air or contrast extravasation then surgery is not indicated
If no evidence of free air or contrast extravasation then surgery is not indicated
Paracentesis
Theraputic peritoneal lavage
Thoracentesis
Hemodialysis/Hemoperfusion
Multidose activated charcoal
Transjugular intrahepatic portosystemic shunt
Activated charcoal
Plasmapheresis