Enteral nutrition in malnourished patients with hepatic cirrhosis and acute encephalopathy.
Ten patients with histologically proven cirrhosis, admitted in grade I to II acute hepatic coma, received in addition to a standard dietary protein free "anticoma" regime, a continuous nasogastric infusion of a branched-chain amino acid enriched chemically defined enteral diet (Hepaticaid) containing an equivalent of 70 g protein/day for a mean of 7.3 days (range 3-23). No complications of therapy were observed and, specifically, the use of fine bore tubes did not provoke variceal hemorrhage. Overall positive nitrogen balance (4.3 +/- 1.7 g N/day) was observed in patients fed 7 or more days. Improvement to coma grade 0 was seen in all patients save one, who died from hepatorenal failure. While serum ammonia levels remained elevated during the study period, there was a significant increase in the branched-chain/aromatic ratio (p less than 0.01) as plasma branched-chain amino acids rose (p less than 0.05) and tyrosine levels fell (p less than 0.05).
D000328:Adult; D000368:Aged; D000597:Amino Acids, Branched-Chain / Q000008:administration & dosage*; D000886:Anthropometry; D001798:Blood Proteins / Q000378:metabolism; D004750:Enteral Nutrition / Q000592:standards*; D005526:Food, Formulated / Q000032:analysis / Q000592:standards*; D006501:Hepatic Encephalopathy / Q000628:therapy*; D006801:Humans; D007441:Intubation, Gastrointestinal; D008104:Liver Cirrhosis, Alcoholic / Q000628:therapy*; D008875:Middle Aged; D009748:Nutrition Disorders / Q000628:therapy*
D000597:Amino Acids, Branched-Chain; D001798:Blood Proteins