Cirrhosis of the liver is characteristically associated with a moderate or a severe degree of undernutrition that is evidenced by wasting of muscle mass and loss of subcutaneous tissue. Massive ascites usually accompanies this state of chronic, severe liver disease, so that the patient with cirrhosis and massive ascites has been likened to a spider because of his large fluid-filled abdomen and spindly extremities. That this state of undernutrition in cirrhosis is often reversible was shown particularly by the classic work of Patek and his colleagues.1 The complications of liver disease, such as massive hematemesis, hepatic coma, and, of more particular concern here, ascites requiring frequent paracenteses, has limited the effectiveness and possible duration of nutritional therapy, thus shortening the time available to permit improvement in nutrition and, presumably, in the liver disease.
Work from a number of clinics has demonstrated that sodium restriction when continuous and of sufficient
Davidson CS. CIRRHOSIS OF THE LIVER TREATED WITH PROLONGED SODIUM RESTRICTIONSIMPROVEMENT IN NUTRITION, HEPATIC FUNCTION, AND PORTAL HYPERTENSION. JAMA. 1955;159(13):1257–1261. doi:10.1001/jama.1955.02960300001001
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