1. Abstinence from alcohol (take psycho-social and psychiatric help if required) |
2. Diet |
1.2–1.5 g of protein per kg of body weight per day (a third from dairy, vegetable protein and animal protein each). Total 35–40 kcal/kg intake per day |
Suggest late evening snack and early breakfast consisting of complex carbohydrates and protein |
Supplement branched chain amino acids |
Use tube feeding (overnight continuous drip) or parenteral nutrition in critically ill patients |
Zinc, vitamin D and other micronutrient deficiency to be corrected |
3. Exercise regime consisting of resistance and aerobic exercised, gently increased in a graded manner as per patient's capacity |
4. Normalization of porta pressure, nonselective beta-blockers or TIPS as indicated |
5. Ammonia lowering measures |
Rifaxamine, laculose, aKG, BCAA |
6. Hormonal therapy |
Testosterone, oxandrolone, growth hormone* |
7. Innovative therapies |
IGF-1, myostatin inhibitors, follostatin, antioxidants, DRP1 inhibitors* |
8. Liver transplantation* |