Goal :
Patients with liver disease, base on the extent of encephalopathy, should greatly benefit from diet control of protein, sodium, and water.
Object
People in hepatic coma (including Phase I, II, III, and IV ).
See Table 1.
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Number
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Symptoms
|
|
Phase I
|
With phase I diabetes, patients often suffer from minor change of mental state, slow speaking, and impatient anxiety, and neglect of their surroundings.
|
|
Phase II
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Aside from more severe conditions of phase I, there are drowsiness, misconduct, and lack of limb coordination.
|
|
Phase III
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Though patients have no trouble waking-up, they still suffer from severe confusion, incoherent, soreness, trembles caused by stiff limbs, and drowsiness.
|
|
Phase IV
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With phase IV, there are loss of senses, pain-free responses, reflex, and peculiar tastes.
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General principles:
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For patients with hepatic coma, moderately restrict their intake of protein base on the extent of their intoxication.
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The general supply of protein per day is 0.5-0.7g/kg with at least 1600-1800 kcal.
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Once patients’ condition is stable a week later, increase the intake of protein weekly up to 1g/kg.
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Once there is liver symptom of encephalopathy, reduce protein supply immediately down to 25-35g/day.
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Stop the intake of high protein like meat, fish, egg, and milk if patients are under severe coma state; instead replace protein with carbohydrate and fat for caloric sources; yet moderate the amount of fat intake in order to prevent poor absorption of fat.
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When patients suffer from severe unconsciousness, there are two means to provide necessary calorie to meet the needs of a body and to prevent patients from the risks of chocking: one is to go for nasogastric tube feeding for nutrients supply and the other is to have intravenous drip for nutritional supplements.
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Vegetable proteins like yellow soy beans contain high branched-chain amino acids which are beneficial for improving conditions of hepatic coma if they are eaten moderately.
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Plant food is often fiber rich which is good in preventing constipation, reducing harmful intestinal bacteria from yielding excessive ammonia.
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If patients suffer from combined esophageal varices, they must not intake any rough, hard, big, deep-fried, and fried food; and always chew thoroughly.
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Alcohol is prohibited; appropriate amount of coffee, black tea, and green tea intake is all right.
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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.)
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To prevent hypoglycemia, intake right amount of snacks for empty stomach at night.
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Follow doctors’ instructions for vitamin supplement.
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Provide balanced diet of calorie and protein to patients with stable recovery of hepatic coma and patients without edema or brain lesions.
中國醫藥大學附設醫院
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