Salt Intake

Patients with cirrhosis tend to retain salt. Cirrhosis can lead to portal hypertension, low albumin levels and increased sodium retention, which can culminate in the development of ascites.

Diet is the first and most important intervention in patients with cirrhosis. In the earliest stages of cirrhosis, urinary sodium excretion is plentiful, and a negative salt balance can be achieved by restricting sodium intake to 2 g per day.

In one series22 of patients referred for a LeVeen peritoneovenous shunt and requiring frequent paracentesis, a careful history revealed that several patients were eating massive quantities of dill pickles (more than 12 g of sodium per day). After these patients stopped consuming pickles, they required no further paracentesis!

Once ascites develops, patients with cirrhosis must continue to follow a sodium-restricted diet. Frequently, these patients also require diuresis, with spironolactone (Aldactone) as first-line therapy and occasional use of a supplemental loop diuretic. (i.e. Lasix)

The liver is the metabolic center for all nutrients. Liver disease can interfere with metabolism in the organ and, thus, can have a negative impact on nutritional status. Because of hepatic damage, patients with cirrhosis can develop marked malnutrition, especially muscle-wasting protein malnutrition.

Therefore, patients with cirrhosis should maintain a balanced diet containing 1 to 1.5 g of protein per kg per day. However, patients with advanced cirrhosis can develop encephalopathy if they consistently consume large portions of protein at one time. These patients should eat small but more frequent servings to maintain a diet of 1 g of protein per kg per day.