Hepatology – Guidelines on Parenteral Nutrition, Chapter 16Hepatologie – Leitlinie Parenterale Ernährung, Kapitel 16

GMS German Medical Science — an Interdisciplinary Journal

T. Schuetz²  M. Plauth¹ 

[1] Dept. of Internal Medicine, Municipal Clinic Dessau, Germany;Medical Department, Division of Gastroenterology, Hepatology and Endocrinology, Charité Universitätsmedizin Berlin, Germany

关键词: acute liver failure;    hepatic encephalopathy;    liver cirrhosis;    alcoholic liver disease;    non-alcoholic fatty liver disease (NAFLD);   

Others  :  869126

实施日期：2009-01-14，发布日期：2009-11-18

【 摘 要 】

Parenteral nutrition (PN) is indicated in alcoholic steatohepatitis (ASH) and in cirrhotic patients with moderate or severe malnutrition. PN should be started immediately when sufficientl oral or enteral feeding is not possible. ASH and cirrhosis patients who can be sufficiently fed either orally or enterally, but who have to abstain from food over a period of more than 12 hours (including nocturnal fasting) should receive basal glucose infusion (2–3 g/kg/d). Total PN is required if such fasting periods last longer than 72 h. PN in patients with higher-grade hepatic encephalopathy (HE); particularly in HE IV° with malfunction of swallowing and cough reflexes, and unprotected airways. Cirrhotic patients or patients after liver transplantation should receive early postoperative PN after surgery if they cannot be sufficiently rally or enterally nourished. No recommendation can be made on donor or organ conditioning by parenteral administration of glutamine and arginine, aiming at minimising ischemia/reperfusion damage. In acute liver failure artificial nutrition should be considered irrespective of the nutritional state and should be commenced when oral nutrition cannot be restarted within 5 to 7 days. Whenever feasible, enteral nutrition should be administered via a nasoduodenal feeding tube.

【 授权许可】

   
© 2009 Plauth et al.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

【 参考文献 】

• [1]Mendenhall CL, Tosch T, Weesner RE, Garcia-Pont P, Goldberg SJ, Kiernan T, Seeff LB, Sorell M, Tamburro C, Zetterman R, et al. VA cooperative study on alcoholic hepatitis. II: Prognostic significance of protein-calorie malnutrition. Am J Clin Nutr. 1986;43(2):213-8.
• [2]Mendenhall CL, Moritz TE, Roselle GA, Morgan TR, Nemchausky BA, Tamburro CH, Schiff ER, McClain CJ, Marsano LS, Allen JI, et al. A study of oral nutritional support with oxandrolone in malnourished patients with alcoholic hepatitis: results of a Department of Veterans Affairs cooperative study. Hepatology. 1993;17(4):564-76. DOI: 10.1002/hep.1840170407 
• [3]Mendenhall CL, Moritz TE, Roselle GA, Morgan TR, Nemchausky BA, Tamburro CH, Schiff ER, McClain CJ, Marsano LS, Allen JI, et al. Protein energy malnutrition in severe alcoholic hepatitis: diagnosis and response to treatment. The VA Cooperative Study Group #275. JPEN J Parenter Enteral Nutr. 1995;19(4):258-65. DOI: 10.1177/0148607195019004258 
• [4]Plauth M, Merli M, Kondrup J, Weimann A, Ferenci P, Müller MJ; ESPEN Consensus Group. ESPEN guidelines for nutrition in liver disease and transplantation. Clin Nutr. 1997;16(2):43-55. DOI: 10.1016/S0261-5614(97)80022-2 
• [5]Achord JL. A prospective randomized clinical trial of peripheral amino acid-glucose supplementation in acute alcoholic hepatitis. Am J Gastroenterol. 1987;82(9):871-5.
• [6]Bonkovsky HL, Fiellin DA, Smith GS, Slaker DP, Simon D, Galambos JT. A randomized, controlled trial of treatment of alcoholic hepatitis with parenteral nutrition and oxandrolone. I. Short-term effects on liver function. Am J Gastroenterol. 1991;86(9):1200-8.
• [7]Bonkovsky HL, Singh RH, Jafri IH, Fiellin DA, Smith GS, Simon D, Cotsonis GA, Slaker DP. A randomized, controlled trial of treatment of alcoholic hepatitis with parenteral nutrition and oxandrolone. II. Short-term effects on nitrogen metabolism, metabolic balance, and nutrition. Am J Gastroenterol. 1991;86(9):1209-18.
• [8]Calvey H, Davis M, Williams R. Controlled trial of nutritional supplementation, with and without branched chain amino acid enrichment, in treatment of acute alcoholic hepatitis. J Hepatol. 1985;1(2):141-51. DOI: 10.1016/S0168-8278(85)80762-5 
• [9]Diehl AM, Boitnott JK, Herlong HF, Potter JJ, Van Duyn MA, Chandler E, Mezey E. Effect of parenteral amino acid supplementation in alcoholic hepatitis. Hepatology. 1985;5(1):57-63. DOI: 10.1002/hep.1840050114 
• [10]Mezey E, Caballería J, Mitchell MC, Parés A, Herlong HF, Rodés J. Effect of parenteral amino acid supplementation on short-term and long-term outcomes in severe alcoholic hepatitis: a randomized controlled trial. Hepatology. 1991;14(6):1090-6. DOI: 10.1002/hep.1840140624 
• [11]Nasrallah SM, Galambos JT. Aminoacid therapy of alcoholic hepatitis. Lancet. 1980;2(8207):1276-7. DOI: 10.1016/S0140-6736(80)92338-7 
• [12]Naveau S, Pelletier G, Poynard T, Attali P, Poitrine A, Buffet C, Etienne JP, Chaput JC. A randomized clinical trial of supplementary parenteral nutrition in jaundiced alcoholic cirrhotic patients. Hepatology. 1986;6(2):270-4. DOI: 10.1002/hep.1840060219 
• [13]Simon D, Galambos JT. A randomized controlled study of peripheral parenteral nutrition in moderate and severe alcoholic hepatitis. J Hepatol. 1988;7(2):200-7. DOI: 10.1016/S0168-8278(88)80483-5 
• [14]Swart GR, Zillikens MC, van Vuure JK, van den Berg JW. Effect of a late evening meal on nitrogen balance in patients with cirrhosis of the liver. BMJ. 1989;299(6709):1202-3. DOI: 10.1136/bmj.299.6709.1202 
• [15]Verboeket-van de Venne WP, Westerterp KR, van Hoek B, Swart GR. Energy expenditure and substrate metabolism in patients with cirrhosis of the liver: effects of the pattern of food intake. Gut. 1995;36(1):110-6. DOI: 10.1136/gut.36.1.110 
• [16]Zillikens MC, van den Berg JW, Wattimena JL, Rietveld T, Swart GR. Nocturnal oral glucose supplementation. The effects on protein metabolism in cirrhotic patients and in healthy controls. J Hepatol. 1993;17(3):377-83. DOI: 10.1016/S0168-8278(05)80221-1 
• [17]John WJ, Phillips R, Ott L, Adams LJ, McClain CJ. Resting energy expenditure in patients with alcoholic hepatitis. JPEN J Parenter Enteral Nutr. 1989;13(2):124-7. DOI: 10.1177/0148607189013002124 
• [18]Österreichische Arbeitsgemeinschaft für klinische Ernährung. Empfehlungen für die parenterale und enterale Ernährungstherapie des Erwachsenen – Version 2004. Wien: AKE; 2004.
• [19]Alberino F, Gatta A, Amodio P, Merkel C, Di Pascoli L, Boffo G, Caregaro L. Nutrition and survival in patients with liver cirrhosis. Nutrition. 2001;17(6):445-50. DOI: 10.1016/S0899-9007(01)00521-4 
• [20]Caregaro L, Alberino F, Amodio P, Merkel C, Bolognesi M, Angeli P, Gatta A. Malnutrition in alcoholic and virus-related cirrhosis. Am J Clin Nutr. 1996;63(4):602-9.
• [21]Harrison J, McKiernan J, Neuberger JM. A prospective study on the effect of recipient nutritional status on outcome in liver transplantation. Transpl Int. 1997;10(5):369-74. DOI: 10.1111/j.1432-2277.1997.tb00931.x 
• [22]Merli M, Riggio O, Dally L. Does malnutrition affect survival in cirrhosis? PINC (Policentrica Italiana Nutrizione Cirrosi). Hepatology. 1996;23(5):1041-6. DOI: 10.1002/hep.510230516 
• [23]Moukarzel AA, Najm I, Vargas J, McDiarmid SV, Busuttil RW, Ament ME. Effect of nutritional status on outcome of orthotopic liver transplantation in pediatric patients. Transplant Proc. 1990;22(4):1560-3.
• [24]Pikul J, Sharpe MD, Lowndes R, Ghent CN. Degree of preoperative malnutrition is predictive of postoperative morbidity and mortality in liver transplant recipients. Transplantation. 1994;57(3):469-72. DOI: 10.1097/00007890-199402150-00030 
• [25]Selberg O, Böttcher J, Pirlich M, Henkel E, Manns M, Müller M. Clinical significance and correlates of whole body potassium status in patients with liver cirrhosis. Hepatology Res. 1999;16(1):36-48. DOI: 10.1016/S1386-6346(99)00036-4 
• [26]Selberg O, Böttcher J, Tusch G, Pichlmayr R, Henkel E, Müller MJ. Identification of high- and low-risk patients before liver transplantation: a prospective cohort study of nutritional and metabolic parameters in 150 patients. Hepatology. 1997;25(3):652-7. DOI: 10.1002/hep.510250327 
• [27]Nutritional status in cirrhosis. Italian Multicentre Cooperative Project on Nutrition in Liver Cirrhosis. J Hepatol. 1994;21(3):317-25. DOI: 10.1016/S0168-8278(05)80308-3 
• [28]Lautz HU, Selberg O, Körber J, Bürger M, Müller MJ. Protein-calorie malnutrition in liver cirrhosis. Clin Investig. 1992;70(6):478-86. DOI: 10.1007/BF00210228 
• [29]Bunout D, Aicardi V, Hirsch S, Petermann M, Kelly M, Silva G, Garay P, Ugarte G, Iturriaga H. Nutritional support in hospitalized patients with alcoholic liver disease. Eur J Clin Nutr. 1989;43(9):615-21.
• [30]Cabre E, Gonzalez-Huix F, Abad-Lacruz A, Esteve M, Acero D, Fernandez-Bañares F, Xiol X, Gassull MA. Effect of total enteral nutrition on the short-term outcome of severely malnourished cirrhotics. A randomized controlled trial. Gastroenterology. 1990;98(3):715-20.
• [31]Kearns PJ, Young H, Garcia G, Blaschke T, O'Hanlon G, Rinki M, Sucher K, Gregory P. Accelerated improvement of alcoholic liver disease with enteral nutrition. Gastroenterology. 1992;102(1):200-5.
• [32]Kondrup J, Müller MJ. Energy and protein requirements of patients with chronic liver disease. J Hepatol. 1997;27(1):239-47. DOI: 10.1016/S0168-8278(97)80308-X 
• [33]Schütz T, Bechstein WO, Neuhaus P, Lochs H, Plauth M. Clinical practice of nutrition in acute liver failure--a European survey. Clin Nutr. 2004;23(5):975-82. DOI: 10.1016/j.clnu.2004.03.005 
• [34]Keohane PP, Attrill H, Grimble G, Spiller R, Frost P, Silk DB. Enteral nutrition in malnourished patients with hepatic cirrhosis and acute encephalopathy. JPEN J Parenter Enteral Nutr. 1983;7(4):346-50. DOI: 10.1177/0148607183007004346 
• [35]Garrison RN, Cryer HM, Howard DA, Polk HC Jr. Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis. Ann Surg. 1984;199(6):648-55. DOI: 10.1097/00000658-198406000-00003 
• [36]Fan ST, Lo CM, Lai EC, Chu KM, Liu CL, Wong J. Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma. N Engl J Med. 1994;331(23):1547-52. DOI: 10.1056/NEJM199412083312303 
• [37]Kanematsu T, Koyanagi N, Matsumata T, Kitano S, Takenaka K, Sugimachi K. Lack of preventive effect of branched-chain amino acid solution on postoperative hepatic encephalopathy in patients with cirrhosis: a randomized, prospective trial. Surgery. 1988;104(3):482-8.
• [38]Reilly J, Mehta R, Teperman L, Cemaj S, Tzakis A, Yanaga K, Ritter P, Rezak A, Makowka L. Nutritional support after liver transplantation: a randomized prospective study. JPEN J Parenter Enteral Nutr. 1990;14(4):386-91. DOI: 10.1177/0148607190014004386 
• [39]Wicks C, Somasundaram S, Bjarnason I, Menzies IS, Routley D, Potter D, Tan KC, Williams R. Comparison of enteral feeding and total parenteral nutrition after liver transplantation. Lancet. 1994;344(8926):837-40. DOI: 10.1016/S0140-6736(94)92824-X 
• [40]Hasse JM, Blue LS, Liepa GU, Goldstein RM, Jennings LW, Mor E, Husberg BS, Levy MF, Gonwa TA, Klintmalm GB. Early enteral nutrition support in patients undergoing liver transplantation. JPEN J Parenter Enteral Nutr. 1995;19(6):437-43. DOI: 10.1177/0148607195019006437 
• [41]Müller MJ, Lautz HU, Plogmann B, Bürger M, Körber J, Schmidt FW. Energy expenditure and substrate oxidation in patients with cirrhosis: the impact of cause, clinical staging and nutritional state. Hepatology. 1992;15(5):782-94. DOI: 10.1002/hep.1840150507 
• [42]Müller MJ, Böttcher J, Selberg O, Weselmann S, Böker KH, Schwarze M, von zur Mühlen A, Manns MP. Hypermetabolism in clinically stable patients with liver cirrhosis. Am J Clin Nutr. 1999;69(6):1194-201.
• [43]Plauth M, Schütz T, Buckendahl DP, Kreymann G, Pirlich M, Grüngreiff S, Romaniuk P, Ertl S, Weiss ML, Lochs H. Weight gain after transjugular intrahepatic portosystemic shunt is associated with improvement in body composition in malnourished patients with cirrhosis and hypermetabolism. J Hepatol. 2004;40(2):228-33. DOI: 10.1016/j.jhep.2003.10.011 
• [44]Nielsen K, Kondrup J, Martinsen L, Døssing H, Larsson B, Stilling B, Jensen MG. Long-term oral refeeding of patients with cirrhosis of the liver. Br J Nutr. 1995;74(4):557-67. DOI: 10.1079/BJN19950158 
• [45]Nielsen K, Martinsen L, Dossing H, Stilling B, Kondrup J. Energy expenditure measured by the doubly labeled water method during hyperalimentation of patients with liver cirrhosis. J Hepatol. 1991;13(Suppl 2):S151.
• [46]Campillo B, Bories PN, Devanlay M, Sommer F, Wirquin E, Fouet P. The thermogenic and metabolic effects of food in liver cirrhosis: consequences on the storage of nutrients and the hormonal counterregulatory response. Metabolism. 1992;41(5):476-82. DOI: 10.1016/0026-0495(92)90204-N 
• [47]Müller MJ, Willmann O, Rieger A, Fenk A, Selberg O, Lautz HU, Bürger M, Balks HJ, von zur Mühlen A, Schmidt FW. Mechanism of insulin resistance associated with liver cirrhosis. Gastroenterology. 1992;102(6):2033-41.
• [48]Riggio O, Merli M, Romiti A, Pinto G, Fanella R, Attili AF, Capocaccia L. Early postprandial energy expenditure and macronutrient use after a mixed meal in cirrhotic patients. JPEN J Parenter Enteral Nutr. 1992;16(5):445-50. DOI: 10.1177/0148607192016005445 
• [49]Campillo B, Fouet P, Bonnet JC, Atlan G. Submaximal oxygen consumption in liver cirrhosis. Evidence of severe functional aerobic impairment. J Hepatol. 1990;10(2):163-7. DOI: 10.1016/0168-8278(90)90046-T 
• [50]DeLissio M, Goodyear LJ, Fuller S, Krawitt EL, Devlin JT. Effects of treadmill exercise on fuel metabolism in hepatic cirrhosis. J Appl Physiol. 1991;70(1):210-5.
• [51]Müller MJ, Dettmer A, Tettenborn M, Radoch E, Fichter J, Wagner TO, Balks HJ, von zur Mühlen A, Selberg O. Metabolic, endocrine, haemodynamic and pulmonary responses to different types of exercise in individuals with normal or reduced liver function. Eur J Appl Physiol Occup Physiol. 1996;74(3):246-57. DOI: 10.1007/BF00377447 
• [52]Plevak DJ, DiCecco SR, Wiesner RH, Porayko MK, Wahlstrom HE, Janzow DJ, Hammel KD, O'Keefe SJ. Nutritional support for liver transplantation: identifying caloric and protein requirements. Mayo Clin Proc. 1994;69(3):225-30.
• [53]Weimann A, Kuse ER, Bechstein WO, Neuberger JM, Plauth M, Pichlmayr R. Perioperative parenteral and enteral nutrition for patients undergoing orthotopic liver transplantation. Results of a questionnaire from 16 European transplant units. Transpl Int. 1998;11 Suppl 1:S289-91.
• [54]Plank LD, Metzger DJ, McCall JL, Barclay KL, Gane EJ, Streat SJ, Munn SR, Hill GL. Sequential changes in the metabolic response to orthotopic liver transplantation during the first year after surgery. Ann Surg. 2001;234(2):245-55. DOI: 10.1097/00000658-200108000-00015 
• [55]Perseghin G, Mazzaferro V, Benedini S, Pulvirenti A, Coppa J, Regalia E, Luzi L. Resting energy expenditure in diabetic and nondiabetic patients with liver cirrhosis: relation with insulin sensitivity and effect of liver transplantation and immunosuppressive therapy. Am J Clin Nutr. 2002;76(3):541-8.
• [56]Merli M, Erikson S, Hagenfeldt H, Wahren J. Splanchnic and peripheral exchange of FFA in patients with liver cirrhosis. Hepatology. 1986;3(3):348-55. DOI: 10.1016/S0168-8278(86)80488-3 
• [57]Merli M, Riggio O, Romiti A, Ariosto F, Mango L, Pinto G, Savioli M, Capocaccia L. Basal energy production rate and substrate use in stable cirrhotic patients. Hepatology. 1990;12(1):106-12. DOI: 10.1002/hep.1840120117 
• [58]Owen OE, Trapp VE, Reichard GA Jr, Mozzoli MA, Moctezuma J, Paul P, Skutches CL, Boden G. Nature and quantity of fuels consumed in patients with alcoholic cirrhosis. J Clin Invest. 1983;72(5):1821-32. DOI: 10.1172/JCI111142 
• [59]Petrides AS, DeFronzo RA. Glucose and insulin metabolism in cirrhosis. J Hepatol. 1989;8(1):107-14. DOI: 10.1016/0168-8278(89)90169-4 
• [60]Selberg O, Burchert W, vd Hoff J, Meyer GJ, Hundeshagen H, Radoch E, Balks HJ, Müller MJ. Insulin resistance in liver cirrhosis. Positron-emission tomography scan analysis of skeletal muscle glucose metabolism. J Clin Invest. 1993;91(5):1897-902. DOI: 10.1172/JCI116407 
• [61]Bianchi G, Marchesini G, Zoli M, Bugianesi E, Fabbri A, Pisi E. Prognostic significance of diabetes in patients with cirrhosis. Hepatology. 1994;20(1 Pt 1):119-25.
• [62]Müller MJ, Pirlich M, Balks HJ, Selberg O. Glucose intolerance in liver cirrhosis: role of hepatic and non-hepatic influences. Eur J Clin Chem Clin Biochem. 1994;32(10):749-58.
• [63]Wolfe RR, Allsop JR, Burke JF. Glucose metabolism in man: responses to intravenous glucose infusion. Metabolism. 1979;28(3):210-20. DOI: 10.1016/0026-0495(79)90066-0 
• [64]Golling M, Lehmann T, Senninger N, Herfarth C, Otto G. Tacrolimus reduction improves glucose metabolism and insulin secretion after liver transplantation. Transplant Proc. 1996;28(6):3180-2.
• [65]Druml W, Fischer M, Pidlich J, Lenz K. Fat elimination in chronic hepatic failure: long-chain vs medium-chain triglycerides. Am J Clin Nutr. 1995;61(4):812-7.
• [66]Müller MJ, Rieger A, Willmann O, Lautz HU, Balks HJ, Von Zur Mühlen A, Canzler H, Schmidt FW. Metabolic responses to lipid infusions in patients with liver cirrhosis. Clin Nutr. 1992;11(4):193-206. DOI: 10.1016/0261-5614(92)90028-O 
• [67]Michel H, Bories P, Aubin JP, Pomier-Layrargues G, Bauret P, Bellet-Herman H. Treatment of acute hepatic encephalopathy in cirrhotics with a branched-chain amino acids enriched versus a conventional amino acids mixture. A controlled study of 70 patients. Liver. 1985;5(5):282-9.
• [68]Wahren J, Denis J, Desurmont P, Eriksson LS, Escoffier JM, Gauthier AP, Hagenfeldt L, Michel H, Opolon P, Paris JC, Veyrac M. Is intravenous administration of branched chain amino acids effective in the treatment of hepatic encephalopathy? A multicenter study. Hepatology. 1983;3(4):475-80.
• [69]Holm E, Leweling H, Saeger H, Arnold V, Gladisch R. Exogenous lipids as a caloric support in hepatic failure. In: Francavilla A, Panella C, Di Leo A, van Thiel D, Hrsg. Liver and hormones. New York: Raven Press; 1987. p. 125-144.
• [70]Naylor CD, O'Rourke K, Detsky AS, Baker JP. Parenteral nutrition with branched-chain amino acids in hepatic encephalopathy. A meta-analysis. Gastroenterology. 1989;97(4):1033-42.
• [71]Mendenhall C, Bongiovanni G, Goldberg S, Miller B, Moore J, Rouster S, Schneider D, Tamburro C, Tosch T, Weesner R. VA Cooperative Study on Alcoholic Hepatitis. III: Changes in protein-calorie malnutrition associated with 30 days of hospitalization with and without enteral nutritional therapy. JPEN J Parenter Enteral Nutr. 1985;9(5):590-6. DOI: 10.1177/0148607185009005590 
• [72]Nielsen K, Kondrup J, Martinsen L, Stilling B, Wikman B. Nutritional assessment and adequacy of dietary intake in hospitalized patients with alcoholic liver cirrhosis. Br J Nutr. 1993;69(3):665-79. DOI: 10.1079/BJN19930068 
• [73]Swart GR, van den Berg JW, van Vuure JK, Rietveld T, Wattimena DL, Frenkel M. Minimum protein requirements in liver cirrhosis determined by nitrogen balance measurements at three levels of protein intake. Clin Nutr. 1989;8(6):329-36. DOI: 10.1016/0261-5614(89)90008-3 
• [74]Fischer JE, Rosen HM, Ebeid AM, James JH, Keane JM, Soeters PB. The effect of normalization of plasma amino acids on hepatic encephalopathy in man. Surgery. 1976;80(1):77-91.
• [75]Freund H, Dienstag J, Lehrich J, Yoshimura N, Bradford RR, Rosen H, Atamian S, Slemmer E, Holroyde J, Fischer JE. Infusion of branched-chain enriched amino acid solution in patients with hepatic encephalopathy. Ann Surg. 1982;196(2):209-20. DOI: 10.1097/00000658-198208000-00015 
• [76]Holm E, Striebel JP, Meisinger E, Haux P, Langhans W, Becker HD. Amino-acid mixtures for parenteral feeding in liver insufficiency [Amino- säurengemische zur parenteralen Ernährung bei Leberinsuffizienz]. Infusionsther Klin Ernahr. 1978;5(5):274-92.
• [77]Cerra FB, Cheung NK, Fischer JE, Kaplowitz N, Schiff ER, Dienstag JL, Bower RH, Mabry CD, Leevy CM, Kiernan T. Disease-specific amino acid infusion (F080) in hepatic encephalopathy: a prospective, randomized, double-blind, controlled trial. JPEN J Parenter Enteral Nutr. 1985;9(3):288-95. DOI: 10.1177/0148607185009003288 
• [78]Fiaccadori F, Ginelli F, Pedretti G, Pelosi G, Sacchini D, Zeneroli M. Branched-chain enriched amino acid solutions in the treatment of hepatic encephalopathy: A controlled trial. Ital J Gastroenterol. 1985;17:5-10.
• [79]Rossi-Fanelli F, Riggio O, Cangiano C, Cascino A, De Conciliis D, Merli M, Stortoni M, Giunchi G. Branched-chain amino acids vs lactulose in the treatment of hepatic coma: a controlled study. Dig Dis Sci. 1982;27(10):929-35. DOI: 10.1007/BF01316578 
• [80]Strauss E, Dos Santos W, Da Silva E. Treatment of hepatic encephalopathy: a randomized clinical trial comparing a branched chain enriched amino acid solution to oral neomycin. Nutr Supp Services. 1986;6:18-21.
• [81]Vilstrup H, Gluud C, Hardt F, Kristensen M, Køhler O, Melgaard B, Dejgaard A, Hansen BA, Krintel JJ, Schütten HJ, et al. Branched chain enriched amino acid versus glucose treatment of hepatic encephalopathy. A double-blind study of 65 patients with cirrhosis. J Hepatol. 1990;10(3):291-6. DOI: 10.1016/0168-8278(90)90135-E 
• [82]Als-Nielsen B, Koretz RL, Kjaergard LL, Gluud C. Branched-chain amino acids for hepatic encephalopathy. Cochrane Database Syst Rev. 2003;(2):CD001939. DOI: 10.1002/14651858.CD001939 
• [83]Plank LD, McCall JL, Gane EJ, Rafique M, Gillanders LK, McIlroy K, Munn SR. Pre- and postoperative immunonutrition in patients undergoing liver transplantation: a pilot study of safety and efficacy. Clin Nutr. 2005;24(2):288-96. DOI: 10.1016/j.clnu.2004.11.007 
• [84]Singer P, Cohen J, Cynober L. Effect of nutritional state of brain-dead organ donor on transplantation. Nutrition. 2001;17(11-12):948-52. DOI: 10.1016/S0899-9007(01)00671-2 
• [85]Prijatmoko D, Strauss BJ, Lambert JR, Sievert W, Stroud DB, Wahlqvist ML, Katz B, Colman J, Jones P, Korman MG. Early detection of protein depletion in alcoholic cirrhosis: role of body composition analysis. Gastroenterology. 1993;105(6):1839-45.
• [86]Garrett-Laster M, Russell RM, Jacques PF. Impairment of taste and olfaction in patients with cirrhosis: the role of vitamin A. Hum Nutr Clin Nutr. 1984;38(3):203-14.
• [87]Weismann K, Christensen E, Dreyer V. Zinc supplementation in alcoholic cirrhosis. A double-blind clinical trial. Acta Med Scand. 1979;205(5):361-6.
• [88]Aggett P. Severe Zinc defiency. In: Mills C, ed. Zinc in Human Biology. London: Springer; 1989. p. 259-274.
• [89]Barry M, Keeling PW, Feely J. Tissue zinc status and drug elimination in patients with chronic liver disease. Clin Sci (Lond). 1990;78(6):547-9.
• [90]Halsted JA, Hackley B, Rudzki C, Smith JC Jr. Plasma zinc concentration in liver diseases. Comparison with normal controls and certain other chronic diseases. Gastroenterology. 1968;54(6):1098-105.
• [91]Thuluvath PJ, Triger DR. Selenium in chronic liver disease. J Hepatol. 1992;14(2-3):176-82. DOI: 10.1016/0168-8278(92)90155-I 
• [92]Grüngreiff K, Abicht K, Kluge M, Presser HJ, Franke D, Kleine FD, Klauck S, Diete U. Clinical studies on zinc in chronic liver diseases. Z Gastroenterol. 1988;26(8):409-15.
• [93]Van der Rijt CC, Schalm SW, Schat H, Foeken K, De Jong G. Overt hepatic encephalopathy precipitated by zinc deficiency. Gastroenterology. 1991;100(4):1114-8.
• [94]Bresci G, Parisi G, Banti S. Management of hepatic encephalopathy with oral zinc supplementation: a long-term treatment. Eur J Med. 1993;2(7):414-6.
• [95]Reding P, Duchateau J, Bataille C. Oral zinc supplementation improves hepatic encephalopathy. Results of a randomised controlled trial. Lancet. 1984;2(8401):493-5. DOI: 10.1016/S0140-6736(84)92567-4 
• [96]Riggio O, Ariosto F, Merli M, Caschera M, Zullo A, Balducci G, Ziparo V, Pedretti G, Fiaccadori F, Bottari E, et al. Short-term oral zinc supplementation does not improve chronic hepatic encephalopathy. Results of a double-blind crossover trial. Dig Dis Sci. 1991;36(9):1204-8. DOI: 10.1007/BF01307509 
• [97]Marchesini G, Fabbri A, Bianchi G, Brizi M, Zoli M. Zinc supplementation and amino acid-nitrogen metabolism in patients with advanced cirrhosis. Hepatology. 1996;23(5):1084-92. DOI: 10.1002/hep.510230523 
• [98]Mills PR, Shenkin A, Anthony RS, McLelland AS, Main AN, MacSween RN, Russell RI. Assessment of nutritional status and in vivo immune responses in alcoholic liver disease. Am J Clin Nutr. 1983;38(6):849-59.
• [99]Schenker S, Halff GA. Nutritional therapy in alcoholic liver disease. Semin Liver Dis. 1993;13(2):196-209. DOI: 10.1055/s-2007-1007349 
• [100]Lieber CS. Alcohol, liver, and nutrition. J Am Coll Nutr. 1991;10(6):602-32.
• [101]Lindor KD. Management of osteopenia of liver disease with special emphasis on primary biliary cirrhosis. Semin Liver Dis. 1993;13(4):367-73. DOI: 10.1055/s-2007-1007365 
• [102]Crippin JS, Jorgensen RA, Dickson ER, Lindor KD. Hepatic osteodystrophy in primary biliary cirrhosis: effects of medical treatment. Am J Gastroenterol. 1994;89(1):47-50.
• [103]Lundbom N, Laurila O, Laurila S. Central pontine myelinolysis after correction of chronic hyponatraemia. Lancet. 1993;342(8865):247-8. DOI: 10.1016/0140-6736(93)92343-R 
• [104]McDiarmid SV, Colonna JO 2nd, Shaked A, Ament ME, Busuttil RW. A comparison of renal function in cyclosporine- and FK-506-treated patients after primary orthotopic liver transplantation. Transplantation. 1993;56(4):847-53. DOI: 10.1097/00007890-199310000-00014 
• [105]Pomposelli JJ, Pomfret EA, Burns DL, Lally A, Sorcini A, Gordon FD, Lewis WD, Jenkins R. Life-threatening hypophosphatemia after right hepatic lobectomy for live donor adult liver transplantation. Liver Transpl. 2001;7(7):637-42. DOI: 10.1053/jlts.2001.26287 
• [106]Smyrniotis V, Kostopanagiotou G, Katsarelias D, Theodoraki K, Hondros K, Kouskouni E. Changes of serum phosphorus levels in hepatic resections and implications on patients' outcomes. Int Surg. 2003;88(2):100-4.
• [107]Tan HP, Madeb R, Kovach SJ, Orloff M, Mieles L, Johnson LA, Bozorgzadeh A, Marcos A. Hypophosphatemia after 95 right-lobe living-donor hepatectomies for liver transplantation is not a significant source of morbidity. Transplantation. 2003;76(7):1085-8. DOI: 10.1097/01.TP.0000085652.47821.8A 
• [108]O'Grady JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet. 1993;342(8866):273-5. DOI: 10.1016/0140-6736(93)91818-7 
• [109]Ganong W. Review of Medical Physiology. East Norwalk: Appleton & Lange; 1991.
• [110]Schneeweiss B, Pammer J, Ratheiser K, Schneider B, Madl C, Kramer L, Kranz A, Ferenci P, Druml W, Grimm G, et al. Energy metabolism in acute hepatic failure. Gastroenterology. 1993;105(5):1515-21.
• [111]Walsh TS, Wigmore SJ, Hopton P, Richardson R, Lee A. Energy expenditure in acetaminophen-induced fulminant hepatic failure. Crit Care Med. 2000;28(3):649-54. DOI: 10.1097/00003246-200003000-00008 
• [112]Samson R, Trey C, Timme A, Saunders S. Fulminating hepatitis with recurrent hypoglycemia and hemorrhage. Gastroenterology. 1967;53:291-300.
• [113]Vilstrup H, Iversen J, Tygstrup N. Glucoregulation in acute liver failure. Eur J Clin Invest. 1986;16(3):193-7. DOI: 10.1111/j.1365-2362.1986.tb01328.x 
• [114]Bernuau J, Rueff B, Benhamou JP. Fulminant and subfulminant liver failure: definitions and causes. Semin Liver Dis. 1986;6(2):97-106. DOI: 10.1055/s-2008-1040593 
• [115]O'Grady JG, Portmann B, Williams R. Fulminant hepatic failure. In: Schoff L, Schiff ER, Hrsg. Diseases of the liver. Philadelphia: Lippincott; 1993. p. 1077-90.
• [116]Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345(19):1359-67. DOI: 10.1056/NEJMoa011300 
• [117]Lin B, Ginsberg MD, Busto R. Hyperglycemic exacerbation of neuronal damage following forebrain ischemia: microglial, astrocytic and endothelial alterations. Acta Neuropathol. 1998;96(6):610-20. DOI: 10.1007/s004010050942 
• [118]Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allannic H, Genetet B. Impaired leucocyte functions in diabetic patients. Diabet Med. 1997;14(1):29-34. DOI: 10.1002/(SICI)1096-9136(199701)14:1<29::AID-DIA300>3.0.CO;2-V 
• [119]Ohyanagi H, Nomura H, Nishimatsu S, Usami M, Kasahara H. The liver and nutrient metabolism. In: Payne-James J, Grimble G, Silk D, Hrsg. Artificial nutrition and support in clinical practice. London: Edward Arnold; 1995. p. 59-71.
• [120]Mahler H, Pasi A, Kramer JM, Schulte P, Scoging AC, Bär W, Krähenbühl S. Fulminant liver failure in association with the emetic toxin of Bacillus cereus. N Engl J Med. 1997;336(16):1142-8. DOI: 10.1056/NEJM199704173361604 
• [121]Schafer DF, Sorrell MF. Power failure, liver failure. N Engl J Med. 1997;336(16):1173-4. DOI: 10.1056/NEJM199704173361609 
• [122]Clemmesen JO, Høy CE, Kondrup J, Ott P. Splanchnic metabolism of fuel substrates in acute liver failure. J Hepatol. 2000;33(6):941-8. DOI: 10.1016/S0168-8278(00)80126-9 
• [123]Forbes A, Wicks C, Marshall W, Johnson P, Forsey P, Williams R. Nutritional support in fulminant hepatic failure: the safety of lipid solutions. Gut. 1987;28:1347-9.
• [124]Kleinberger G. Parenteral nutrition in liver insufficiency [Parenterale Ernährung bei Leberinsuffizienz]. Schweiz Med Wochenschr. 1986;116(17):545-9.
• [125]Clemmesen JO, Kondrup J, Ott P. Splanchnic and leg exchange of amino acids and ammonia in acute liver failure. Gastroenterology. 2000;118(6):1131-9. DOI: 10.1016/S0016-5085(00)70366-0 
• [126]Record CO, Buxton B, Chase RA, Curzon G, Murray-Lyon IM, Williams R. Plasma and brain amino acids in fulminant hepatic failure and their relationship to hepatic encephalopathy. Eur J Clin Invest. 1976;6(5):387-94. DOI: 10.1111/j.1365-2362.1976.tb00533.x 
• [127]Rosen HM, Yoshimura N, Hodgman JM, Fischer JE. Plasma amino acid patterns in hepatic encephalopathy of differing etiology. Gastroenterology. 1977;72(3):483-7.
• [128]Frydén A, Weiland O, Mårtensson J. Successful treatment of hepatic coma probably caused by acute infectious hepatitis with balanced solution of amino acids. Scand J Infect Dis. 1982;14(3):177-80.
• [129]Hensle T, Blackburn GL, O'Donnell T, McDermott WV Jr. Intravenous feeding in hepatic failure. Surg Forum. 1973;24:388-91.
• [130]Schmidt LE, Dalhoff K. Serum phosphate is an early predictor of outcome in severe acetaminophen-induced hepatotoxicity. Hepatology. 2002;36(3):659-65. DOI: 10.1053/jhep.2002.35069