Nutritional Management Acute Liver Failure

The nutritional status of someone with acute liver failure versus chronic liver failure can differ greatly. The primary goal of the nutritional management in acute liver failure is supportive. An increase in nausea, vomiting, and anorexia may be associated with acute liver disease, which may result in decreased oral intake. If normal nutritional status prior to the insult is assumed, the patient will have a much higher nutritional reserve than that of a patient in chronic liver failure. Energy needs can be met by providing the Dietary Reference Intakes for infants and children and approximately 30kcal/kg for adults. The provision of adequate protein is crucial in fulminant hepatic failure and encephalopathy. Adequate protein must be provided to minimize catabolism, which may exacerbate any hyperammonemia present. Excessive protein intake should be avoided because it may increase ammonia levels.

Protein recommendations for adults and teenagers are 0.5-1.0 g/kg/day and for infants and children 1.2-1.5 g/kg/day. Additional protein restrictions or an increase in the intake of branched-chain amino acids intake may be beneficial. In health, the ratio of branched-chain amino acids/aromatic amino acids (leucine + isoleucine + valine/phenylalanine + tyrosine) = ~3:1, and in liver failure the ratio may decline to ~1, often in association with some degree of hepatic encephalopathy. There are data indicating that normalization of this ratio by administration of branched-chain amino acid formulae can improve hepatic encephalopathy.

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