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How To Keep Blood Ammonia Under Control With Diet When Suffering From Liver Cirrhosis?

Posted on Tue, 13 May 2014

Question: My Husband has liver disease, cirrhosis . Sept 2013 was admitted to hospital with esphogeal varices and they were banded. They are doing blood work this week to see if there is a coexisting cause besides drinking alcohol. He has had ammonia in his blood 3 times with the range of 40 to the last being 89. We would like to know how to keep this ammonia under control with diet etc. besides the lactulose and he just started xifaxan 550mg and hast had any alcohol or meds that compromise the liver. We feel we aren't getting a straight answer on what to do about this disease and how to cope or help keep things from progressing. besides the obvious . Also how serious is this? Thank you. what is the prognosis for liver disease and what are good questions to ask next time we see our Dr?

Answered by Dr. Enrique Molina (53 minutes later)

Brief Answer: serious Detailed Answer: your husband is having the complications of end stage liver disease. the fact that he had varices that required banding, and has elevated ammonia leading to "hepatic encephalopathy" is serious. He is getting blood work to make sure nothing else is contributing to the liver damage, however alcohol is enough to cause this. Abstaining from alcohol is paramount, however the liver problems will not reverse. Once the liver is scarred down (enough to cause esophageal varices and encephalopathy or high ammonia) then there is no liver regeneration. The only way to "cure" the liver problems are through a liver transplant. This will depend on his "MELD" score. Ask your doctor what is his score (calculated based on some of his labs). If the MELD score is >15 then he qualifies to be listed for transplant. He needs to be abstinent from alcohol for a few months, and show proof. He needs to be checked for liver cancer as well, and get some sort of liver imaging every 6 months indefinitely (as liver cancer develops more commonly in patients with cirrhosis). The MELD score will also determine the prognosis you are asking about. Hopefully that helps, let me know if you have further questions or concerns.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Enrique Molina (1 hour later)

Thank you. What does meld stand for ? Abbreviation ? This is very concerning The dr we just saw said he can have a long normal life if we keep an eye on things. Another dr said it was mild scarring. I guess next step is another ultra sound and biopsy. What outcome have you seen without transplant ? No alcohol of course and what about diet or non traditional meds ? Also he takes two oxycodone for a neck fusion he had a couple years ago. Is there something better for pain Managment that is safer for the liver ? Thanks so much !

Answered by Dr. Enrique Molina (8 hours later)

Brief Answer: see below Detailed Answer: MELD stands for Model for End Stage Liver Disease. It is a formula which involves a few of the laboratory studies that reflect the liver function. Patients with cirrhosis may live a long normal life if it is early scarring, but the fact that he has varices and high ammonia, this is suggestive of advanced scarring of the liver. The outcome without liver transplant depends on his MELD score and how functional he is. Oxycodone builds up in the system, as it is cleared by the liver, therefore he should avoid it, particularly if he has high ammonia. It can make him confused. He should talk to a pain management specialist to see what is the best option. The diet recommendation is low salt diet, to avoid building up fluid in the system, which is common in patients with cirrhosis. The only non-traditional medication i can suggest is Milk Thistle. It is not going to cure him, but may help him. biopsy is not necessary to diagnose cirrhosis. Diagnosis can be made by imaging, laboratory studies and physical exam.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Enrique Molina (2 days later)

Good Evening Dr. Molina, My Husband went and had a CT scan, it showed Micro nodular scarring of his liver. What is the prognosis for this and can we some how reverse this in the future? Thank you Monica

Answered by Dr. Enrique Molina (15 minutes later)

Brief Answer: cirrhosis Detailed Answer: micro nodular scarring on a CT scan means he has cirrhosis. it does not help to estimate the prognosis. This is not reversible. The best thing he can do is avoid alcohol as i had mentioned. Prognosis is better estimated with the MELD score that i had mentioned above for which you need some laboratory studies (INR, bilirrubin, creatinine and sodium) hope that helps

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar