[Parenteral nutrition in liver insufficiency].

In recent years various regimens for parenteral nutrition in liver insufficiency, containing glucose and fat for energy supply and a liver-adapted amino acid mixture for nitrogen supply, have been recommended. The substrates should be delivered in an all-in-one-solution which facilitates metabolic monitoring and decreases the risk of infections. For treatment of hepatic encephalopathy (HE), branched chain amino acids (BCAA) are recommended. The separation of parenteral nutrition from the treatment of HE makes it much easier to adapt the dosage of the BCAA to the clinical symptoms of the patients. In patients with a severe decrease of gluconeogenesis (spontaneous hypoglycemia below 3 mmol/l combined with a hyperlactemia above 7 mmol/l) or a decreased elimination rate of ammonia (production rate of urea nitrogen below 5 g/l combined with hyperammonemia above 100 mumol/l), an exogenous amino acid supply is not indicated.