ABSTRACT
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The liver is responsible for providing the appropriate amount of substrate needed for the adequate function of other organ systems. To this end, the liver plays a major role in carbohydrate, protein, and fat metabolism; storage of nutrients; and regulation of substrate availability, as described in Table 30.1. Hepatic failure, which can be divided into two categories — acute, or fulminant, and chronic liver failure — can adversely affect any of these activities. In addition, the liver of patients with hepatic failure is often challenged by undernourishment due to the prevalence of malnutrition. Therefore, the provision of nutritional support to patients with hepatic failure can be a life-saving treatment modality. An important aspect of critically ill patients with hepatic failure, whether acute or chronic, is hepatic encephalopathy, primarily because of its relative protein intolerance.
