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Ernährung und Leberversagen

Nutrition and liver failure

Medizinische Klinik - Intensivmedizin und Notfallmedizin volume 108, pages 391–395 (2013)Cite this article

Zusammenfassung

Die Ernährung kritisch kranker Leberpatienten unterscheidet sich nicht grundsätzlich von der anderer kritisch Kranker. Bei hyperakutem Leberversagen kommt der Ernährungstherapie eine geringere Bedeutung zu als bei den anderen, länger verlaufenden Formen des akuten Leberversagens. In erster Linie sollte eine enterale Ernährung mit polymeren Standardnahrungen über eine nasoenterale Sonde eingesetzt werden und erst bei deren Versagen die parenterale Ernährung mit Glukose, Fett, Aminosäuren, Vitaminen und Spurenelementen. Bei chronisch Leberkranken, insbesondere Zirrhosepatienten, ist die sehr häufig vorbestehende Eiweißmangelernährung von prognostischer Bedeutung und erfordert den sofortigen Beginnn der Ernährungstherapie. Ziel der vorzugsweise enteralen Ernährung ist die Sicherstellung einer angemessenen Energie- und Eiweißzufuhr. Besonderes Augenmerk verdient die Vermeidung des Refeeding-Syndroms und der Ausgleich von Mikronährstoffdefiziten.

Abstract

In the critically ill liver patient, nutrition support is not very different from that given for other illnesses. In hyperacute liver failure, nutrition support is of less importance than in the other subtypes of acute liver failure that take a more protracted course. Nasoenteral tube feeding using a polymeric standard formula should be the first-line approach, while parenteral nutrition giving glucose, fat, amino acids, vitamins, and trace elements is initiated when enteral nutrition is insufficient or impracticable. In chronic liver disease, notably cirrhosis, there is frequently protein malnutrition indicating a poor prognosis and requiring immediate initiation of nutrition support. Enteral nutrition ensuring an adequate provision of energy and protein should be preferred. Particular care should be taken to avoid refeeding syndrome and to treat vitamin and trace element deficiency.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung/en hin: Vortragshonorare von Baxter, Nestlé, Fresenius-Kabi, Falk Foundation.

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  1. Klinik für Innere Medizin, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau, Deutschland

    M. Plauth

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Plauth, M. Ernährung und Leberversagen. Med Klin Intensivmed Notfmed 108, 391–395 (2013). https://doi.org/10.1007/s00063-012-0200-4

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Schlüsselwörter

  • Enterale Ernährung
  • Enzephalopathie
  • Eiweißmangel
  • Isoleucin
  • Leberzirrhose

Keywords

  • Enteral nutrition
  • Encephalopathy
  • Protein malnutrition
  • Isoleucine
  • Liver cirrhosis