HEPATIC FAILURE

Hepatic failure is also known as enlarged liver disease. Liver function is severely reduced due to reduction in the number of functional liver cells. This affects a number of reaction such as:

• Conversion of ammonia to urea is disturbed, accumulated ammonia is toxic to the central nervous system.
• The breakdown of aromatic amino acids is reduced (phenylalnine, tyrosine and tryptophan) and these accumulate in the blood.
• Branched chain amino acids (leucine, isoleucine and valine) are broken  in peripheral muscle for energy and their blood level decreases.

DIET:-

The main principle is to reduce protein intke to minimize ammonia production. 

This can be done as follows:

• Protein free to low protein diet - 20 to 30g is given for a few days. As improvement occurs, protein intake is increased by 5 to 10g every few days, until the intake reaches 40 to 50 per day. The protein profile can be improved by ensuring intake of branched chain amino acids, orally, enterally or parenterally.
• To prevent tissue breakdown, 1500 - 2000kcal are provided in the form of carbohydrates and fat.
• Patients, who are unable to take nourishment orally, tube feeding or parenteral  nutrition is given.