INTERNAL MEDICINE
Appropriate Restriction of
Protein in Liver Disease
Dr Liesel van der Merwe BVSc (Hons) MMedVet (Med)
Small Animals.
Protein restriction should not be the default when a patient is diagnosed with liver disease.
Liver disease can manifest in many different forms:
portosystemic vascular anomalies (PSVA/“shunts”),
chronic or acute hepatitis, suppurative or non-suppurative cholangiohepatitis, toxic hepatitis, hepatic lipidosis, fibrosis and neoplasia.
It is likely that protein deficiency occurs in veterinary
patients with active necroinflammatory disorders, and
possibly those treated with glucocorticoids. In many
of these conditions the patient is ill, not eating properly, and the liver is undergoing active damage due to
inflammation and/or infection or toxic damage. The
patient will require protein to provide “building blocks”
for regeneration and recovery. Protein and sufficient
energy will also be required to maintain lean muscle
mass.
As a rule of thumb - protein should not be restricted
in liver disease unless hepatic encephalopathy (HE) is
present. Hepatic encephalopathy manifests in various ways. Mild changes include poor appetite, being
a poor doer, intermittent gastrointestinal signs, and
lethargy. More severe clinical signs can include disorientation, central blindness, stupor and seizures.1, 2
Don’t restrict dietary protein to
prevent HE - rather restrict dietary
protein if HE is present and try
feeding the highest level of dietary
protein possible without causing a
recurrence of HE.
Hepatic encephalopathy is reversible.
Decrease the dietary protein levels and
the clinical signs will resolve.
Most veterinary patients with liver disease are not in
hepatic failure and do not suffer from hepatic encephalopathy. 1,2
Common hepatic disorders in dogs, which are not
often associated with HE, are vacuolar hepatopathy,
chronic infections, chronic active hepatitis, major bile
vet360
Issue 02 | APRIL 2016 | 14
April 2016 Vet360 for Madaleen Review.indd 14
2016/03/24 2:24 PM