Fasting state for cirrhosis patients
10-12 hrs
resting EE in cirrhosis
>30% and persist for 1 year post transplant
Vitamins deficiencies in liver disease
- A rare
- DEK
- B12 rare long term
- B6
- B9 common
Thiamine deficiency causes
Wer-nicke's encephalopathy
Kossak-off psychosis
Dry weight for ascites and edema
- Minimal 2.2 1
- moderate 6. 5
- Sever 14. 10
Golden standard assessment tool for per liver transplant
RFH SGA (4 domains )
measurement to predict 1 year mortality post-transplant and sarcopenia
Psoas Muscle Area (L3 PMA)
Nutritional requirements
Compensated 25-35 kcal/kg/d. 1.2-1.3 g
Decompensated 35-40 kcal/kg/d. 1.2-1.5 g
Post transplant 30% stress factor. 1.2-1.5g
No added salt diet content
recommended over low sodium diet
80-100 mmol/d
Glucose and AA requirement in alcoholic steatohepatitis and cirrhosis
IV 2-3 g/kg/day (fasting for >12 hrs)
50-60% of non-protein energy requirements
AA 1.2-1.5 g/kg/day
B1 prior to glucose infusion
ESPEN in Acute liver failure
IV 2-3 g/kg/day
Lipids 0.8-1.2 g/kg/day (if IR)
AA 0.8-1.2 g/kg/day
Is creatinine related to dietary protein intake
No, proportionate to muscle mass
marker for renal function, inadequate dialysis or muscle catabolism
Potassium goal, hyper, hypo levels, when to not restrict intake
goal 3.5-5.5 meq/l K+ number of lines = upper limit K=lower
hyper >6 meq/l
Urine >1000ml/day or serum normal level
CRF requirements
35 kcal/kg/day
Protein 0.55-0.6 g/kg/day
Po4 600-1000 mg/d
K+ 1500-2000 mgday
Na 1.8-2.5 g/day
Proposed solution to preserve renal function
Essential AA + ketoanalogues (low protein)
ESRF requirements
Protein intake (g/kg/day): 1.2–1.4 (50% HBV)
• Energy intake kcal/kg/day: 35
• Mineral Requirements:
– Phosphate (mg/day) 800–1000 or <17 mg/kg IBW (if GFR< 20-30 ml/min)
– Potassium (mg/g) 2000–2500 or 40mg/kg of IBW
– Sodium (g/day) 1.8–2.5
– Fluid (ml) 1000+urine volume
HD >5% weight gain reflect
reflect excessive fluid intake
HD Fluid gains of <2% reflect
Loss of body mass
Sodium and fluid balance based on urine output
- ≥ 1 L fluid output: 2-4 g Na and 2 L fluid
– ≤ 1 L fluid output: 2 g Na and 1-1.5 L fluid
– Anuria: 2 g Na and 1 L fluid
PD requirements
Energy: 35 kcals/kg/day
Sodium: (2-4 g/day)
Potassium: is easily cleared by PD
• Calcium: (<2000 mg elemental calcium)
– ~1500 mg: calcium-based phosphate binders
• Phosphorus: <800-1000 mg/day
– Use phosphate binders
• Fluid: can be adjusted by varying the dextrose
concentrations of the dialysate