Enteral Nutrition in Malnourished Patients with Hepatic Cirrhosis and Acute Encephalopathy

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Abstract
Ten patients with histologically proven cirrhosis, admitted in grade I to III 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 < 0.01) as plasma branched‐chain amino acids rose (p < 0.05) and tryosine levels fell (p < 0.05). (Journal of Parenteral and Enteral Nutrition 7:346–350, 1983)