(3) Ammonia that cannot be converted to urea by the diseased liver will
escape into the circulatory system. Excess blood ammonia can be very toxic to the
(4) Blood ammonia levels are monitored by the physician, who determines
dietary protein allowances accordingly.
c. The patient should be instructed to avoid table salt, salted butter and
margarine, salty foods, and processed foods, which are generally high in sodium.
(1) "Salt substitutes" such as lemon juice, herbs, and spices should be used
to enhance food flavor.
Commercial salt substitutes must be approved by the physician before
d. If fluid retention (manifested by edema or ascites) occurs, the physician may
order dietary restrictions such as:
e. Intake of substances that are toxic to the liver must be stopped.
f. A patient with cirrhosis will experience anorexia, and will require
encouragement and even enticement to eat the prescribed, well-balanced diet.
(1) Consider individual patient preferences, and ask the dietician to use
preferred foods in the menu.
Small, frequent meals may be better tolerated than three large meals.
Make meal times as pleasant and leisurely as possible.
g. Ensure that the patient takes the prescribed supplementary vitamins. A
diseased liver cannot effectively store or activate vitamins. Supplementary vitamins
prescribed may include the following:
(1) Vitamin K. Vitamin K, known as the anti-hemorrhagic vitamin, is a fat-
soluble vitamin normally stored in the liver. It is essential for the synthesis of
prothrombin, a substance necessary for normal blood clotting.