Table 4.

Summary of Nutrition, Fluid, and Sodium Recommendations for Patients With Chronic Liver Disease

• All patients with chronic liver disease should undergo a baseline nutritional assessment, repeated at routine intervals or with change of clinical condition5, 8

• Enteral feeds through a nasoenteral tube are indicated in patients who cannot reach caloric intake goals with oral supplements; parenteral feeds are reserved for patients who cannot reach caloric intake goals by oral or enteral routes

• Optimal energy intake: 25–40 kcal/kg/day5, 10

• Protein intake

○ Daily protein intake: 1.2–1.5 g/kg,5, 8 0.6–0.8 g/kg if acute encephalopathy10

○ Small meals evenly distributed through the day and a bedtime snack of complex carbohydrates minimizes muscle loss3

○ Branched‐chain amino acid supplementation may help achieve daily protein goals in patients who are protein intolerant8

• Moderate sodium restriction (80–120 mmol sodium/day or 4.6–6.9 g salt/day) is a mainstay of therapy in ascites14

• Fluid restriction is not recommended until serum sodium decreases to <120–125 mmol/L15