Nutritional Management of Hepatic Encephalopathy

  • Robert H. Bower
  • Josef E. Fischer
Part of the Advances in Nutritional Research book series (ANUR)


Hepatic insufficiency is a common consequence of critical illness. The liver’s multiplicity of processes and its position astride the portal vein, where it receives nutrients and prepares them for distribution to the periphery, make it the central organ in any metabolic scheme. It is precisely this central role which causes the derangements of these processes in hepatic insufficiency to affect all phases of body economy.


Hepatic Encephalopathy Aromatic Amino Acid Neutral Amino Acid Plasma Amino Acid Hepatic Insufficiency 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Alexander, J. W., Macmillan, B. G., Stinnett, J. D., Ogle, C. K., Bozian, R. C., Fischer, J. E., Oakes, J. B., Morris, M. J., and Krummel R., 1980, Beneficial effects of aggressive protein feeding in severely burned children, Ann. Surg. 192: 505.Google Scholar
  2. Baldessarini, R. J., and Fischer, J. E., 1973, Serotonin metabolism in rat brain after surgical diversion of the portal venous circulation, Nature (London) 245: 25.Google Scholar
  3. Buse, M. G., and Reid, J., 1975, Leucine, a possible regulator of protein turnover in muscle, J. Clin. Invest. 56: 1250.CrossRefGoogle Scholar
  4. Cardelli-Cangiano, P., Cangiano, C., James, J. H., Jeppsson, B., Brenner, W., and Fischer, J. E., 1981, Uptake of amino acids by brain microvessels isolated from rats after portacaval anastomosis, J. Neurochem. 36 (2): 627.CrossRefGoogle Scholar
  5. Cremer, J. E., Lal, J. C., and Sarna, G. S., 1977, Rapid blood-brain transport and metabolism of butyrate and pyruvate after portacaval anastomosis, J. Physiol. (London) 266: 70 P.Google Scholar
  6. Dawson, A. M., and Sherlock, S., 1957, Effect of an amine oxidase inhibitor on arterial ammonium levels of liver disease, Lancet 1: 1332.CrossRefGoogle Scholar
  7. Dismukes, K., 1977, New look at the aminergic nervous system, Nature (London) 269:557. Dodsworth, J. M., James, J. H., Cummings, M. C., and Fischer, J. E., 1974, Depletion of brain norepinephrine in acute hepatic coma, Surgery 75: 811.Google Scholar
  8. Eigler, N., Sacca, L., and Sherwin, R. S., 1979, Synergistic interactions of physiologic investment of glucagon, epinephrine and cortisol in the dog. A model for stress induced hyperglycemia, J. Clin. Invest. 63: 114.CrossRefGoogle Scholar
  9. Fernstrom, J. D., and Faller, D. V., 1978, Neutral amino acids in brain: Changes in response to food ingestion, J. Neurochem. 30: 1531.CrossRefGoogle Scholar
  10. Fischer, J. E., and Baldessarini, R. J., 1971, False neurotransmitters and hepatic failure, Lancet 2: 75.CrossRefGoogle Scholar
  11. Fischer, J. E., and James, J. H., 1972, Treatment of hepatic coma and hepatorenal syndrome: Mechanism of action of L-dopa and aramine, Am. J. Surg. 123: 222.CrossRefGoogle Scholar
  12. Fischer, J. E., Yoshimura, N., Aguirre, Alfonso, James, J. H., Cummings, M. G., Abel, R. M., and Deindoerfer, F., 1974, Plasma amino acids in patients with hepatic encephalopathy: Effects of amino acid infusions, Am. J. Surg. 127: 40.CrossRefGoogle Scholar
  13. Fischer, J. E., Rosen, H. M., Ebeid, A. M., James J. H., Keane, J. M., and Soeters, P. B., 1976, The effect of normalization of plasma amino acids on hepatic encephalopathy in man, Surgery 80: 77.Google Scholar
  14. Freund, H., Yoshimura, N., and Fischer, J. E., 1979, Chronic hepatic encephalopathy. Long-term therapy with a branched-chain amino-acid-enriched element diet, J. Am. Med. Assoc. 242: 347.CrossRefGoogle Scholar
  15. Freund, H. R., James, J. H., and Fischer, J. E., 1981, Nitrogen sparing mechanisms of singly administered branched chain amino acids in the injured rat, Surgery 90: 237.Google Scholar
  16. Herlong, H. F., Maddrey, W. C., and Walser, M., 1980, The use of ornithine salts of branched-chain ketoacids in portal-systemic encephalopathy, Ann. Int. Med. 93: 545.CrossRefGoogle Scholar
  17. Horst, D., Grace, N., Conn, H. O., Schiff, E., Schenker, S., Viteri, A., Law, D., and Atterbury, C. E., 1981, A double-blind randomized comparison of dietary protein and an oral branched-chain amino acid supplement in cirrhotic patients with chronic portal-systemic encephalopathy, Hepatology 1:518 (Abstract).Google Scholar
  18. Hoyumpa, A. M., Desmond, P. V., Avant, G. R., Roberts, R. K., and Schenker, S., 1979, Hepatic encephalopathy, Gastroenterology 76: 184.Google Scholar
  19. Iber, F. L., Rosen, H., Levenson, S. M., and Chalmers, T. C., 1957, The plasma amino acids in patients with liver failure, J. Lab. Clin. Med. 50: 417.Google Scholar
  20. James, J. H., Escourrou, J., and Fischer, J. E., 1978, Blood-brain neutral amino acid transport activity is increased after portacaval anastomosis, Science 200: 1395.CrossRefGoogle Scholar
  21. James, J. H., Jeppsson, B., Ziparo, V., and Fischer, J. E., 1979, Hyperammonaemia, plasma amino acid imbalance, and blood-brain amino acid transport: A unified theory of portal-systemic encephalopathy, Lancet 2: 772–775.CrossRefGoogle Scholar
  22. Jeppsson, B., Gimmon, Z., James J. H., Nobin, A., and Fischer, J. E., 1980, Infusion of NH salts changes brain neurotransmitters, Gastroenterology 79: 1028 (Abstract).Google Scholar
  23. Oldendorf, W. K., 1971, Brain uptake of radiolabeled amino acids, amines, and hexoses after arterial injection, Am. J. Physiol. 221: 1629.Google Scholar
  24. Rosen, H. M., Yoshimura, N., Hodgman, J. M., and Fischer, J. E., 1977, Plasma amino acid patterns in hepatic encephalopathy of differing etiology, Gastroenterology 72: 483.Google Scholar
  25. Rosen, H. M., Soeters, P. B., James, J. H., Hodgman, J., and Fischer, J. E., 1978, Influences of exogenous intake and nitrogen balance on plasma and brain aromatic amino acid concentrations, Metabolism 27: 393.CrossRefGoogle Scholar
  26. Rossi-Fanelli, F., Riggio, O., Cangiano, C., Cascino, A., DeConciliis, D., Merli, M., Stortoni, M., and Giunchi, G., 1982, Branched-chain amino acids vs. lactulose in the treatment of hepatic coma: A controlled study, Dig. Dis. Sci., 27: 929–935.CrossRefGoogle Scholar
  27. Smith, A. R., Rossi-Fanelli, F., Ziparo, V., James, J. H., Perelle, B. A., and Fischer, J. E., 1978, Alterations in plasma and CSF amino acids, amines and metabolities in hepatic coma, Ann. Surg. 187: 343.CrossRefGoogle Scholar
  28. Soeters, P. B., and Fischer, J. E., 1976, Insulin, glucagon, amino acid imbalance and hepatic encephalopathy, Lancet 2: 880.CrossRefGoogle Scholar
  29. Svec, M. H., and Freeman, S., 1949, Effect of impaired hepatic circulation on plasma free amino acids of dogs, Am. J. Physiol. 159: 357.Google Scholar
  30. Wade, L. A., and Katzman, R., 1975, Synthetic amino acids and the nature of L-dopa transport at the blood-brain barrier, J. Neurochem. 25: 837.CrossRefGoogle Scholar
  31. Warren, K. S., and Schenker, S., 1964, Effect of an inhibitor of glutamine synthesis (methionine sulfoximine) on ammonia toxicity and metabolism, J. Lab. Clin. Med. 64: 442.Google Scholar
  32. Zieve, L., 1981, The mechanism of hepatic coma, Hepatology 1: 360.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1983

Authors and Affiliations

  • Robert H. Bower
    • 1
  • Josef E. Fischer
    • 2
  1. 1.Hyperalimentation UnitUniversity of Cincinnati Medical CenterCincinnatiUSA
  2. 2.Department of SurgeryUniversity of Cincinnati Medical CenterCincinnatiUSA

Personalised recommendations