Clinical decompensation history | Advice | Monitoring |
---|---|---|
Ascites | ||
Adherence with diuretics Do not add salt to food or when cooking Restaurant meals, take-out foods, and tinned foods generally contain high levels of sodium Sea salt, Himalayan rock salt, and table salt have similar sodium content Caution with salt substitutes—may contain high levels of potassium Avoid nonsteroidal anti-inflammatory analgesics Highly educated and/or engaged participants: restrict sodium intake to 2000 mg daily | Weigh self weekly if dose of diuretics is stable and ascites is well-controlled Weigh self daily if diuretic dose changes or poorly controlled ascites; notify clinic if postural symptoms/dizziness develop Document weight – do not just “remember” Do not restrict fluid intake unless advised to by a doctor Development of fevers and/or chills accompanied by abdominal pain and/or discomfort—present to the emergency department for assessment | |
Encephalopathy | ||
Adherence with lactulose (with or without rifaximin) Do not drink alcohol Avoid sleeping tablets and opiate analgesics Do not drive unless your doctor has told you it is okay to do so Medication assistance may be required in severe memory disturbance Highly educated and/or engaged participants: discuss accumulation of ammonia and other toxins | Be mindful of worsening mood disturbances, personality changes, and sleep inversion Family member or carer to help monitor for signs of deterioration Titrate lactulose dose to achieve two or three loose bowel motions daily; reduce/withhold if diarrhea or severe bloating occurs Violent, irrational behavior or loss of consciousness—call an ambulance immediately | |
Hepatocellular carcinoma | Attend follow-up ultrasound appointments as scheduled | |
Jaundice, itch | ||
Antihistamines are not very effective Use soap-free body wash Moisturize skin daily | Get blood tests as directed Acute or recurrent yellowing of eyes and skin—see a doctor as soon as possible | |
Malnourishment | ||
Eat small, frequent meals regardless of appetite Eat a bedtime snack Choose protein- and calorie-rich snacks Take supplements as directed Use an antiemetic if required Do not drink alcohol | Weigh self once weekly Keep a food diary See a dietitian for expert advice | |
Variceal bleeding | ||
Adherence with propranolol (with or without proton pump inhibitor) Highly educated and/or engaged participants: discuss portal hypertension and development of varices | Attend endoscopic surveillance as scheduled Monitor blood pressure, postural symptoms, dizziness Check hemoglobin and iron stores as appropriate Hematemesis or melena—call an ambulance immediately |