Chronic Liver Disease

Chronic liver disease is often accompanied by nutritional deficiencies. The goals of nutritional management are to provide adequate energy and protein to prevent energy deficits and protein catabolism and to

Table 4 Management of chronic liver failure in children Nutritional support

Energy intake, 120-150% (recommended daily amount) Carbohydrate, 15-20 g/kg/day Protein, 3-4 g/kg/day

Fat, 8g/kg/day (50% medium-chain triglyceride) Fat-soluble vitamins

Fluid balance

Avoid excess sodium (<2mmol/kg)

Ascites: spironolactone (3mg/kg), furoseimide (0.5-2 mg/kg), albumin infusion, paracentesis

Encephalopathy

Low protein (2 g/kg) Lactulose (5-20 ml/day)

Coagulopathy

Vitamin K (2-10mg/day)

Fresh frozen plasma, cryoprecipitate, platelets

From Kelly DA (2002) Managing liver failure. Postgraduate Medical Journal 78: 660-667.

promote hepatic cell growth. Recommendations for nutritional management of children with chronic liver disease are presented in Table 4. The energy need for adults with chronic liver disease is 30-35 kcal/kg/day. Energy requirements are increased to compensate for the weight loss that often occurs in cirrhosis. Protein should be provided as 0.8-1 g/kg for adults; unnecessary protein restriction should be avoided because it may only worsen total body protein losses. Energy from fat is best delivered as MCTs due to malabsorption of long-chain fatty acids. Several infant, pediatric, and adult formulas are available with a large percentage of fat in the form of MCTs.

Supplementation with fat-soluble vitamins (A, D, E, and K) in water-miscible solutions is necessary due to the potential for deficiencies associated with fat malabsorption. Serum levels should be monitored regularly to ensure appropriate levels and prevent toxicity. Supplementation with zinc, selenium, iron, and calcium should be given as needed. Copper and manganese should not be supplemented because they are excreted via the bile and may build to toxic levels. Sodium and/or fluid restrictions may be necessary in cirrhosis characterized by ascites and edema. This can impose difficulty because this restriction decreases the palatability of the diet, further decreasing oral intake.

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