A client with severe cirrhosis presents with elevated ammonia levels. Which of the following dietary modifications should the nurse prioritize for the client to help manage ammonia levels?

Severe cirrhosis impairs the liver’s ability to detoxify ammonia, a byproduct of protein metabolism, leading to hyperammonemia and hepatic encephalopathy. Dietary management is an important supportive strategy in reducing ammonia load and preventing neurologic deterioration. In advanced liver disease, protein metabolism must be carefully balanced to minimize toxin buildup while still supporting essential body functions. Nutrition adjustments therefore focus on controlling protein intake rather than eliminating overall nutrition. Rationale: A. Increasing protein intake to promote healing and recovery is inappropriate in severe cirrhosis with elevated ammonia levels. Excess protein metabolism increases ammonia production, which the damaged liver cannot effectively convert into urea. This can worsen hepatic encephalopathy, leading to confusion, lethargy, and decreased level of consciousness. B. Incorporating high-fiber foods is beneficial for bowel health, but stopping lactulose is unsafe in this context. Lactulose helps reduce ammonia by trapping it in the gut and promoting its excretion through stool. Discontinuing it would allow ammonia levels to rise, worsening neurologic symptoms. C. Reducing protein intake to minimize ammonia production during digestion is the priority dietary modification. Protein breakdown produces nitrogenous waste, including ammonia, which accumulates in cirrhosis due to impaired hepatic detoxification. Controlled protein restriction helps lower ammonia levels and reduces the risk of hepatic encephalopathy exacerbation while still maintaining adequate nutrition. D. Eliminating carbohydrates completely is not appropriate because carbohydrates are an essential energy source for clients with liver disease. Removing carbohydrates can lead to muscle breakdown for energy, which paradoxically increases ammonia production. A balanced diet with adequate calories from carbohydrates is necessary to prevent catabolism and further metabolic stress.