Loss of weight due to liver disease (urgent)

Subject: Medical Consultation Request – Severe Weight Loss in Patient with MDS and Liver Cirrhosis

I am reaching out to seek your expert opinion regarding my father’s current medical condition, which has become increasingly concerning over the past few months. I will summarize his case and highlight the main urgent issue.

Background:

Age: 65

Primary Diagnosis: Myelodysplastic Syndrome (MDS), diagnosed approximately 8 years ago.

Additional Conditions: Liver cirrhosis with recurrent ascites, iron overload (on X-JADE), severe muscle wasting (sarcopenia), and chronic poor appetite.

Medications: X-JADE (iron chelation), Hepa-Merz (liver support), Spironolactone 50 mg daily for ascites, occasional diuretics, and other supportive medications as needed.

Recent History:

Significant Weight Loss: Four months ago, he weighed ~74 kg before therapeutic paracentesis for ascites. After the first drainage, his weight dropped to ~62 kg. Following recurrent ascites and another drainage, his weight has now dropped to ~52 kg.

This represents a loss of approximately 30% of body weight within 4 months, despite attempts to increase caloric intake.

His daily intake is variable, but due to persistent nausea, early satiety, and severe muscle weakness, he is unable to consume large meals.

We have tried high-calorie drinks and nutrient-dense snacks between meals, but the weight loss continues.

He currently shows severe generalized fatigue, marked muscle wasting, and difficulty maintaining basic activity, though he has no jaundice, overt hepatic encephalopathy, or active bleeding.

Ascites recurs rapidly after drainage, indicating possible refractory ascites.

Main Concern:
The most alarming issue now is rapid and severe weight loss with progressive sarcopenia, despite nutritional support efforts.
Given his combined MDS + advanced liver disease, I am concerned about:

Entering a state of refractory cachexia

Further decline in muscle mass leading to impaired mobility, respiratory weakness, and increased infection risk

Difficulty tolerating even minor illnesses or interventions

Questions:

1. In such a case, what evidence-based interventions would you recommend to halt or slow down the weight loss immediately?

2. Would specialized medical nutrition (e.g., BCAA-enriched formulas, parenteral nutrition, or nasogastric feeding) be advisable at this stage?

3. Are there safe pharmacologic appetite stimulants or metabolic modulators for someone with both MDS and liver cirrhosis?

4. Given the rapid recurrence of ascites, could an approach like TIPS be considered, or would his hematologic condition pose too high a risk?

I would highly appreciate any guidance or suggestions based on your expertise, as my priority now is to prevent further weight decline and preserve his functional capacity.

Thank you in advance for your time and consideration.

Best regards,
Yazan Jamous