What is the preferred diet for a patient with cirrhosis with increased ammonia levels?

A. Increased protein diet: Increasing protein intake can raise ammonia levels because protein metabolism produces nitrogenous waste. In cirrhosis, impaired hepatic detoxification limits conversion of ammonia to urea. Excess protein may worsen hepatic encephalopathy symptoms. B. Decreased sodium diet: Sodium restriction is commonly used to manage ascites and edema in cirrhosis. While important for fluid balance, it does not directly reduce ammonia production or levels. This intervention addresses volume status rather than encephalopathy risk. C. Decreased protein diet: Reducing dietary protein lowers ammonia generation from intestinal breakdown of amino acids. This approach helps decrease neurotoxic ammonia accumulation when hepatic clearance is compromised. Protein intake is often temporarily restricted during episodes of elevated ammonia. D. Increased carbohydrate diet: Carbohydrates provide an alternative energy source and can help prevent protein catabolism. While beneficial as part of overall nutrition, increasing carbohydrates alone does not directly reduce ammonia production. It is supportive rather than primary management for hyperammonemia.