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Table 2 Medication-related education provided to intervention participants receiving pharmacotherapy for chronic liver failure-related complications

From: Patient-oriented education and medication management intervention for people with decompensated cirrhosis: study protocol for a randomized controlled trial

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