Clinical practice of nutrition in acute liver failure--a European survey

Evidence-based guidelines for artificial nutrition in hyperacute (HLF), acute (ALF) and subacute liver failure (SLF) cannot be given at present due to scarcity of clinical studies.

Current nutritional practice was surveyed using a questionnaire which was answered by 33 hepatology units (2-170 cases/year) in 11 European countries.

All units used specific nutrition support regimes in liver failure patients. Eight units (385 patients/year) preferentially used tube-feeding with standard diets, 25 units (377 patients/year) used parenteral nutrition (PN). For PN glucose was infused at 4.0 g/kg d (median; range 0.6-10.0). Intravenous fat was given only by some units: (18/33) in HLF at 0.9 g/kg d (0.3-2.0), (21/33) in ALF at 1.0 g/kg d (0.3-2.0), and (23/33) in SLF at 1.0 g/kg d (0.3-3.0). Amino acid solutions, predominantly enriched in branched-chain amino acids, were used in HLF (19/33 units) and in ALF (23/33) at 0.9 g/kg d (0.5-1.5) and in SLF (24/33) at 1.0 g/kg d (0.7-1.5).

Hepatology units use a considerable variety of specific nutrition support strategies in liver failure. About 50% of patients receive enteral nutrition. Dosage and monitoring of PN is similar to other critical illness with a wide variety of infusion rates and accepted ranges of substrate plasma concentrations.