[Artificial nutrition in liver failure]

Area of Science:

• Hepatology
• Clinical Nutrition
• Critical Care Medicine

Context:

• Liver failure presents complex nutritional and metabolic challenges.
• Metabolic derangements, including amino acid imbalances, are implicated in hepatic encephalopathy.
• Optimal nutritional strategies are crucial for patient recovery and preventing complications.

Purpose:

• To review current evidence and guidelines for nutritional and metabolic support in patients with liver failure.
• To evaluate the efficacy of specialized nutritional solutions in acute liver failure and post-liver transplantation.
• To provide recommendations for nutrient composition, administration routes, and micronutrient supplementation.

Summary:

• Current data do not support routine use of specialized amino acid solutions (enriched in branched-chain amino acids, low in aromatic amino acids) for acute liver failure or liver transplant recipients.
• Enteral nutrition is the preferred route for nutrient administration in critically ill patients with liver failure whenever feasible.
• Nutrient composition should be adapted to the metabolic stress of liver failure, rather than using "liver failure-specific" diets. Lipid infusions are permissible in parenteral nutrition, and increased vitamin/micronutrient intake is advised.
• Early postoperative nutritional intake via transpyloric route is recommended for liver transplant recipients.

Impact:

• Informs clinical practice regarding evidence-based nutritional management of liver failure.
• Highlights the importance of individualized nutritional support tailored to metabolic stress.
• Guides the selection of appropriate nutritional therapies to improve patient outcomes and recovery.