Critically ill patients may present with acute liver failure or may develop it as part of multiple-organ failure. In both cases patients are generally catabolic, malnourished, and intolerant of water, sodium, and protein. The aim of treatment is to reduce catabolism, thus decreasing the plasma level of poorly tolerated aromatic and sulfated amino acids, and to support protein synthesis.
Extreme caution is needed when treating these patients. Calorie load (avoid overfeeding) and composition (3 70 per cent glucose), as well as amino acid load (30-50 g/day) and composition (titrate infusion of branched-chain, aromatic, and sulfurated amino acids on plasma profile), must be carefully checked ( Nitenberg 1993).
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