Goal

Depending on the degree of liver disease of the patient, the protein, sodium and water in the diet should be appropriately modified to facilitate the control of liver coma.

General principles

1. Protein restriction and nutritional support 35-40 kcal/kg/day energy intake, 1.2-1.5 g/kg/day protein intake. Patients with liver cirrhosis are usually malnourished, and protein restriction is associated with increased mortality. Therefore, patients with hepatic encephalopathy usually should not restrict protein intake.

• Patients with mild to moderate hepatic encephalopathy can usually receive oral nutrition.
• Patients with severe hepatic encephalopathy usually do not receive oral nutrition. When unconsciousness occurs, in order to meet the basic energy needs of the body and avoid the risk of choking, it is recommended to place a nasogastric tube to supplement nutrition with the tube; also, follow the instructions of the nutritionist or doctor to supplement the nutrition from the vein if need.
• Patients with hepatic coma during the recovery period are stable, and patients without edema or coma can be given a balanced diet with appropriate amounts of protein and calories.

2. In patients whose symptoms worsen with protein intake, replacing fish or meat with vegetable protein and dairy products can improve nitrogen balance and mental state.
3. Another option for patients with protein intolerance is to add 0.25 g/kg/day branched chain amino acids (BCAA) to a low-protein diet. BCAA supplementation is only suitable for patients with severe protein intolerance. Generally speaking, only patients with transjugular intrahepatic hilar system shunt or surgical hilar system shunt have severe hepatic encephalopathy, which is enough to ensure the use of plant protein or supplementation of BCAA to limit protein.
4. Plant food is often fiber rich which is good in preventing constipation, reducing harmful intestinal bacteria from yielding excessive ammonia.
5. If patients suffer from combined esophageal varices, they must not intake any rough, hard, big, deep-fried, and fried food; and always chew thoroughly.
6. Alcohol is prohibited; appropriate amount of coffee, black tea, and green tea intake is all right.
7. Because ammonia is also seen as one of the factors attributing to hepatic coma, avoid eating food with high level of ammonia (e.g., sausages, ham, bacon, cheese, peanut butter, beer yeast, and animal tenders.)
8. It is recommended that patients eat small and frequent meals (4-6 meals a day), and take complex carbohydrates before going to bed, because fasting will lead to protein metabolism and increase ammonia production.
9. Follow doctors’ instructions for vitamin supplement.