What is the appropriate nutrition therapy for ascites?

• A. Fluid and sodium restriction; protein 0.8-1.2 g/kg/day for maintenance and 1.3-2.0 g/kg/day for repletion
• B. No restrictions on fluids or sodium; protein 0.5 g/kg/day
• C. Fluid restriction only; sodium unrestricted; protein 0.8 g/kg/day
• D. Sodium restriction only; fluid unrestricted; protein 0.5-1.0 g/kg/day

Answer: (A)

Managing nutrition in ascites centers on controlling fluid balance and providing adequate protein to support nutrition without worsening fluid buildup. Limiting sodium helps reduce ascites by decreasing water retention, and fluid restriction is only needed in specific cases of significant hyponatremia or fluid overload, not routinely. Protein should be kept adequate to prevent malnutrition and loss of lean body mass: about 0.8–1.2 g/kg/day for maintenance, with higher intake, around 1.3–2.0 g/kg/day, used for repletion or when there is malnutrition or catabolic stress. This combination—sodium and fluid restriction plus appropriate protein intake—best supports ascites management and overall nutrition. The other options either miss one of the restrictions or propose an inappropriately low protein level for this population.