In liver disease, energy expenditure is usually increased especially in which conditions?

• A. Only in cachexia
• B. With dehydration
• C. In absence of infection
• D. With infections and ascites

Answer: (D)

In liver disease, resting energy expenditure rises most when the patient has infection or ascites. An infection triggers a systemic inflammatory response with cytokines that accelerate metabolism and protein breakdown, driving higher energy needs. Ascites reflects advanced liver disease and adds metabolic demands from fluid overload, increased work of breathing, and altered substrate turnover, all contributing to a higher energy expenditure even at rest. Dehydration by itself doesn’t typically elevate metabolic rate in this context, and being without infection removes a major driver of hypermetabolism. While cachexia involves weight loss and catabolism, the combination of infection and ascites is the situation most consistently associated with increased energy expenditure in liver disease.