Protein- und Aminosäurenstoffwechsel bei Leberinsuffizienz — Infusionstherapeutische und diätetische Folgerungen

  • E. Holm
  • H. Leweling
  • U. Staedt
  • J.-P. Striebel
  • A. Tschepe
  • W. Uhl
Conference paper
Part of the Verhandlungen der Deutschen Gesellschaft für Innere Medizin book series (VDGINNERE, volume 92)

Zusammenfassung

Die heutigen Tendenzen und Richtlinien bezüglich der Versorgung leberinsufïizienter Patienten mit Eiweiß bzw. Aminosäuren ergeben sich überwiegend aus metabolischen Erkenntnissen und kontrollierten klinischen Studien der letzten 10 Jahre; sie kontrastieren in quantitativer und qualitativer Hinsicht mit älteren Vorstellungen. Subtile Methoden der Beschreibung des Proteinhaushalts und des Ernährungszustands (Abschnitt 1) haben zusammen mit einer verbesserten Diagnostik früher Phänomene der hepatischen Enzephalopathie (HE) annähernd zufriedenstellende Effektivitätskriterien nutritiver Maßnahmen geliefert. Des weiteren ist die rationale Basis dieser Maßnahmen durch neue Einblicke in den Aminosäuren- und Ammoniakstoffwechsel (Abschnitt 2) wie auch in die Entstehungsweise der HE (Abschnitt 3) stabiler und breiter geworden. Daß hepatologisch konzipierte Aminosäurengemische bei entsprechend gefährdeten Kranken eine risikofreie und effiziente parenterale Ernährung ermöglichen, wußte man schon zu Beginn der vergangenen Dekade. Davon zu unterscheiden ist das erst in jüngster Zeit ausreichend legitimierte Bestreben, durch Anwendung solcher Aminosäurengemische präkomatöse und komatöse Zustände nicht nur zu vermeiden, sondern auch adjuvant zu behandeln (Abschnitt 4). Auf dem Sektor der oralen Ernährung lief die Entwicklung ungefähr parallel, wobei allerdings das Fazit aus den bislang verfügbaren Befunden mehr die Prophylaxe der HE als deren Therapie betrifft (Abschnitt 5).

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Copyright information

© J. F. Bergmann Verlag, München 1986

Authors and Affiliations

  • E. Holm
    • 1
  • H. Leweling
    • 1
  • U. Staedt
    • 1
  • J.-P. Striebel
    • 1
  • A. Tschepe
    • 1
  • W. Uhl
    • 1
  1. 1.Abteilung für Pathophysiologie, I. Medizinische Klinik und Institut für Anästhesiologie, Klinikum MannheimUniversität HeidelbergDeutschland

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