Liver disease Flashcards
Energy needs for patients with >25% liver function
Increased energy for PEM
- 1.2-1.4 if no acites
- 1.5.1.75 if ascites, sepsis, infection, fever or need for repletion
CHO needs for patients with >25% liver function
High CHO diet - must be individualized (55-64% kcals)
Hypoglycemia in acute liver disease
Hyperglycemia in 2/3 of pt with cirrhosis
Lipid needs for patients with >25% liver function
Lipids -25-40% (steatorrhea in 50% of patients - MCT oil)
Malabsorption - low fat diet
Protein needs for patients with >25% liver function
Protein -Increased requirements for liver repair & to replenish stores
- 0.8 - 1.0 g/kg for uncomplicated hepatitis/cirrhosis
- 1.2-1.3 to promote N accumulation
1. 5 for sepsis, GI bleeding, severe ascites, repletion
Vitamin and mineral needs for patients with >25% liver function
Supplementation needed in all patients
Fat soluble vitamins given in water soluble form
IV vit K given for 3 days
Water soluble vitamins - B1, B6, B12, Folate, Niacin
Minerals - no manganese and copper, calcium, magnesium, zinc
Thiamin needs in liver disease
Wernicke’s encephalopathy - reversible with thiamin
Fluid and electrolyte needs for patients with >25% liver function
Restrict sodium with edema or ascited
Fluid restriction to 1 to 1.5 l/day if ascities
MNT for hepatic failure <25% function
recommendations same as liver disease - PRO restriction may exacerbate PRO breakdown in body
Branched chain amino acids - used by the muscle and do not need to be broken down by the liver - improve insulin resistance in males - nocturnal administration
- competes with AAA for brain uptake
Casein based diets lower in AAA and higher in BCAA
Also vegetable protein
Decrease ammonia in gut by neomycin (antibiotic that destroys gut flora)
lactulose (induces diarrhea)
MNT for liver transplant
Energy - pretransplant 1.2 or more
immediately post - 1.15-1.3
protein - 1-1.5 g/kg immediately post (1st 2 months) - 1.2 - 1.75 g/kg
Enteral nutrition is vital because of stimulation of portal hepatotrophic factors needed for liver cell proliferation
low bacterial diets post op ( no raw eggs, caesar salad dressing, avoid salad bars and buffets, medium well or rare meats, cheeses and meat from deli counter)
What is the MNT for steatorrhea?
45-60 ml/day of MCT oil
15 mL = 115 kcal
How to restrict fluid in diet?
Consider sources such as drinking water, milk, juices, soups, gruels, coffee, tea, soft drinks and alcoholic beverages
Syrup or juice served with canned fruit
Foods that are liquid at body temp/frozen desserts
Milk in pudding, sauces etc.
Avoid sodium so not thirsty (deal with thirst/dryness without drinking (cold sliced fruit, sour candy, spray mouthwash)
How to incorporate MCT in diet?
Combine oil with beverages (skim milk/ fruit juice)
Substitute MCT for vegetable oils
Use it to stir fry vegetables/grill meats - use low heat/low smoke point
Use it in baking (egg whites in place of whole eggs)
How to plan fat restricted diet?
Use skim milk in severe restriction
Avoid cream cheese, hard cheese (choose low fat 1%)
Avoid high fat meats, remove skin, use skim milk cheese
Avoid most baked desserts except angel food cake and fortune cookies
Avoid cream sauces and gravies
Avoid bread and cereal products made with fat (doughnuts, fritters, muffins)
Avoid candies made with chocolate, nuts or any fats
No avocado
Limit alcohol
symptoms associated with liver disease
acidosis ketonemia hyperlipidemia--> reduce CHO hypoglycemia --> increase CHO Ascites --> increase energy Jaundice Encephalopathy - BCAA
