What foods should be contraindicated in patients with hepatic coma?

The core dietary taboo for patients in the onset of hepatic coma is excessive intake of high-protein foods, especially high-protein foods derived from animals. This is a red line that is repeatedly emphasized by clinical gastroenterology departments and is often violated by family members.

I encountered such a case when I was in the gastroenterology department last year. The 58-year-old Zhou was a patient with alcoholic liver cirrhosis who had been drinking for more than 30 years. He was rescued from liver coma for the first time only three days after he woke up. His son felt sorry for him because he had lost more than 20 pounds during his hospitalization. He secretly brought the oxtail soup from home that had been simmered for an afternoon, and deliberately skimmed off three layers of it to prevent him from finding it too oily. Oil slick, I was quite happy to see Lao Zhou drink two large bowls in a row. However, in the evening of that day, Lao Zhou started not to recognize anyone. He sat on the bed, pulled out the infusion tube and shouted to go home. The blood ammonia test soared to 210 μmol/L, more than three times the normal upper limit. It took another three days to get him back. The young man cried so hard in the doctor's office that he couldn't even speak.

In fact, the logic behind it is straightforward. The cause of most hepatic coma is the complete collapse of the liver's metabolic capacity. The ammonia produced by the decomposition of the protein eaten should be converted into urea by the liver and excreted in the urine. However, it cannot be processed now. The free ammonia flows along the blood and flows into the brain, disrupting the normal operation of the nerve function. At least it is drowsy and confused, unable to recognize people, and in worst cases, it directly falls into a deep coma. Giving the patient high-protein food at this time is equivalent to "filling ammonia" directly into his blood, which will only make the condition worse.

However, the protein intake in the past two years has not been entirely without controversy. At the provincial digestive nutrition annual meeting not long ago, some nutrition experts suggested that if the patient is completely deprived of protein for more than half a month, the patient's own muscles will begin to decompose for energy, which will produce more endogenous blood ammonia, and subsequent recovery will be much slower. Therefore, in clinical practice, it is not that no protein is allowed to be touched from beginning to end. The attack must be completely stopped. After the patient is fully conscious and the blood ammonia has stabilized in the normal range for several consecutive reexaminations, the amount can then be increased little by little. Plant proteins such as tofu and soy milk are preferred. The rate of ammonia rise is much slower than that of animal protein. It is also easier to digest and less likely to cause problems.

In addition to high protein, there are two types of food that must be avoided. One is any alcoholic beverage. Even a small amount of cooking wine is best not added to cooking. The already overburdened liver cannot handle this extra metabolic burden.； The other type is commercial nutritional supplements purchased privately by family members and added with a large amount of amino acids and animal protein. Many people think that "it is right to drink some nutritional powder if the patient cannot eat." However, if they just feed them casually without asking the doctor in advance, the probability of being cheated is really high.

To be honest, arranging diet for patients recovering from hepatic coma is really like teaching a child who has just learned to stand to walk. It must be done slowly and steadily. Don't always think about making a fat person in one bite. If you think it is hurting, it may not be helpful.