title: NUTRITIONAL SUPPORT FOR FULMINANT HEPATITIS.
abstract: BACKGROUND
  fulminant hepatitis (FH) is associated with exacerbated hypercatabolism, hypoglycemia and hyperammonemia that are accompanied by the release of proinflammatory cytokines and catabolic hormones into the systemic circulation worsening patient's clinical condition. Nutritional support is a crucial element for the recovery of these patients.
  
  
  OBJECTIVE
  the aim of this review is to update Nutritional Support for Fulminant Hepatitis.
  
  
  METHODS
  the review was performed using electronic search on Medline-PubMed using Mesh-terms.
  
  
  CONCLUSIONS
  there are not many data available on nutritional support to fulminant hepatitis or acute liver failure. Strategies for initial nutritional intervention are focused on the control of the previously described FH metabolic derangements, and should be individualized according to the severity of patient's clinical condition. Energy and protein can be provided in amounts of 25‑40 kcal/kg/day and 0.8-1.2 g/kg/day, respectively. Enteral nutrition therapy is indicated for patients with advancing encephalopathy or for those who cannot be properly fed orally. Euglycemia must be achieved and protein intake can be based on BCAA formulae. Lipids can be administered as energy supplementation with caution. Adequate nutrition therapy can potentially reduce morbidity and mortality of FH patients.
authors.affiliation: Hospital das Clínicas from University of Sao Paulo School of Medicine, Discipline of Digestive Surgery and LIM37, Department of Gastroenterology, Sao Paulo.. estelafigueira@me.com.
authors.forename: Estela Regina
authors.initials: ER
authors.lastname: Ramos Figueira
authors.affiliation: Hospital das Clínicas from University of Sao Paulo School of Medicine, Discipline of Anesthesiology (LIM08), Sao Paulo.. estelafigueira@me.com.
authors.forename: Joel Avancini
authors.initials: JA
authors.lastname: Rocha Filho
authors.affiliation: Hospital das Clínicas from University of Sao Paulo School of Medicine, Discipline of Liver and Gastrointestinal Transplant (LIM37), Department of Gastroenterology, Sao Paulo.. estelafigueira@me.com.
authors.forename: Lucas
authors.initials: L
authors.lastname: Souto Nacif
authors.affiliation: Hospital das Clínicas from University of Sao Paulo School of Medicine, Discipline of Liver and Gastrointestinal Transplant (LIM37), Department of Gastroenterology, Sao Paulo.. estelafigueira@me.com.
authors.forename: Luiz
authors.initials: L
authors.lastname: Carneiro D'Albuquerque
authors.affiliation: Hospital das Clínicas from University of Sao Paulo School of Medicine, Discipline of Digestive Surgery (LIM35), Department of Gastroenterology, Sao Paulo, Brazil.. estelafigueira@me.com.
authors.forename: Dan
authors.initials: D
authors.lastname: Linetzky Waitzberg
mesh_terms: D004750:Enteral Nutrition; D005526:Food, Formulated; D005947:Glucose / Q000378:metabolism; D006801:Humans; D017114:Liver Failure, Acute / Q000628:therapy*; D044623:Nutrition Therapy / Q000379:methods*; D018529:Nutritional Support / Q000379:methods*
chemical_list: D005947:Glucose