Preventive approaches in chronic liver diseases part III: Decompensated liver cirrhosis

Medical complications are frequent in patients with decompensated liver cirrhosis (LC). This article addresses preventive measures in the setting of decompensated LC. A 2 gram sodium and 1-1.5 grams of protein per kilogram of body weight per day diet is recommended. The use of prophylactic antibiotic in spontaneous bacterial peritonitis (SBP) is considered only in selected cases, and never exceeding six months. A maximum dose of furosemide 40 mg/day and spironolactone up to 300 mg/day is recommended to prevent hepato-renal syndrome. Patients presenting with severe acute alcoholic hepatitis should be considered for Pentoxifylline. Cirrhotics presenting with SBP should be treated with antibiotics and albumin infusion, reducing the chances of HRS development. Magnesium supplementation (for prevention of muscle cramps), end of life discussion (if no candidate for liver transplantation), urea containing moisturizers (preventing lower extremities cellulitis) and intermittent histamine H₁ blockers (for sleep disturbances) as needed should be considered in these patients.