Avoid hepatotoxic drugs and alcohol.
Rest and reduced physical activity are recommended.
Normal diet. Protein restriction indicated only when encephalopathy is evident. Severe protein restriction may accentuate catabolism. Use increments of 20 g protein per day as tolerated.
Monitor blood glucose regularly because hypoglycaemia is common.
Correct electrolyte disturbances.
Exclude GI bleed as precipitant.
Avoid any measure, e.g. drugs, that may worsen or precipitate functional deterioration.
Avoid vigorous paracentesis.
Exclude infection as precipitant, especially spontaneous bacterial peritonitis.
On admission to change pH of large bowel:
Lactulose, oral, 10–30 mL immediately.
Thereafter, to attain 2–3 soft stools a day:
Lactulose, oral, 10–30 mL 8 hourly.
o Titrate dose to 2–3 soft stools a day.
Vitamin K1, IM/IV, 5–10 mg daily.
Other vitamins if indicated.
Multivitamin supplements should be considered and may be indicated.
» Where a liver transplant is to be considered.
Reference and further reading
Standard Treatment Guidelines and Essential Medicines List for South Africa 2012 Edition