Protein diet in liver failure

[Apoplexy__]

I've heard Goljan audio say that you restrict protein in liver failure due to urea cycle compromise. I've also read somewhere else that you use a high-protein diet in liver failure to compensate for hypoalbuminemia. Which is it?

Or is it more a management of symptoms sort of thing?
Edema and worsening ascites --> BMP shows low albumin --> high-protein diet
Neurological symptoms --> BMP shows uremia --> low-protein diet

Couldn't find a definitive answer with a cursory Google search. Thanks for the help in advance.

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[Brain Bucket]

In class, so can't really look this up, but it's an interesting q. I'd imagine it would depend on etiology as well as progression.

Towards end stage, I can't see a choice but to pumping up protein and managing the encephalopathy.

Try the GI forum?

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[Apoplexy__]

Towards end stage, I can't see a choice but to pumping up protein and managing the encephalopathy.

Ah, yeah that sounds like a logical compromise. Thanks, I might ask GI too later.

Checked in Robbins, doesn't really talk about patient management...

 

[ulikedaggers]

I've heard Goljan audio say that you restrict protein in liver failure due to urea cycle compromise. I've also read somewhere else that you use a high-protein diet in liver failure to compensate for hypoalbuminemia. Which is it?

Or is it more a management of symptoms sort of thing?
Edema and worsening ascites --> BMP shows low albumin --> high-protein diet
Neurological symptoms --> BMP shows uremia --> low-protein diet

Couldn't find a definitive answer with a cursory Google search. Thanks for the help in advance.

It's going to depend on the etiology. I'm only an M1 so I don't have specific details for you, but we just covered some of this in biochem.

With MCAD and urea cycle deficiencies, for example, you'd restrict proteins.

On the other hand, if the liver issue is such that there's a negative nitrogen balance you could treat with high protein. We didn't learn about any specific diseases that cause a negative nitrogen balance though.

 

[Apoplexy__]

On the other hand, if the liver issue is such that there's a negative nitrogen balance you could treat with high protein.

Interesting idea with the nitrogen balance guiding therapy. You could probably just go on a patient-by-patient basis and assess BUN, urine urea, and serum protein.

Found this article, which basically says what we've all been saying: Both options can be right. Specifically, the article says you let protein intake be normal or high if there's malnutrition, and restrict only in the case of severe encephalopathy:
http://www.medscape.com/viewarticle/575158_4

As an aside, the same issue comes up in nephrotic syndrome complicating renal failure. You have a negative nitrogen balance in a condition you'd normally restrict protein in. A quick glance at Wiki says you'd restrict protein (because you'd just pee it out anyway), then give an IV albumin solution if the edema is so extreme that the patient is at risk for severe pulmonary edema.

Ah well, just wanted to make sure that protein restriction AND supplementation were both possibilities given the context. I'm sure the info in a board question stem would be sufficient to figure it out.

 

[Brain Bucket]

Makes sense.

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[mollybaby]

if you are suffering from liver disease you should take care of the following diet prescription like you should increase the intake of carbohydrates but in proportion. Cut down the intake of protein because it limit building up toxic waste. take medicine and vitamin prescribed by your doctor for nerve problem, nutritional problem from liver disease. limit the intake of salt intake because it may result swelling in the liver.