[Parenteral nutrition in liver diseases]. / Die parenterale Ernährung bei Lebererkrankungen.

ABSTRACT

A total parenteral nutrition may particularly be used in patients with liver diseases, for comatous patients or postoperatively. By using central venous catheterization the practical application of high osmolar solutions, fat emulsions and amino acid mixtures is easy to be performed. Partial parenteral nutrition is needed mainly for decompensation of metabolic disturbances of amino acids in liver diseases. As carbohydrates particularly glucose is used, but because of the deranged glucose tolerance also fructose and glucose substitutes are given in mixed solutions. The infusion of fat emulsions partly covers the need of energy and on the other side prevents a lack of essential fatty acids. Recent investigations demonstrated that fat emulsions may be tolerated by patients with liver diseases and fat is utilized for energy metabolism. The changes of plasma amino acids in blood in patients with chronic liver diseases, especially in the stage with liver insufficiency, demands for a special amino acid solution. For the accomplishment of a total as well as for partial parenteral nutrition principles are given and relevant clinical problems are discussed.