# Nutritional Management of Liver Failure in the Intensive Care Unit

## TL;DR

This paper discusses how proper nutrition in the ICU can help manage liver failure by supporting body function and reducing complications.

## Contribution

The paper provides a clinical overview of current evidence and guidelines for nutritional management in liver failure patients in the ICU.

## Key findings

- Enteral nutrition is preferred for liver failure patients, with parenteral nutrition used only when necessary.
- Micronutrient repletion and avoiding refeeding syndrome are critical in nutritional management.
- Multidisciplinary approaches improve outcomes in ICU patients with liver failure.

## Abstract

Liver failure, both acute and chronic, represents a complex, life-threatening condition frequently requiring intensive care unit (ICU) admission. Nutritional management is a crucial component of supportive therapy, aiming to mitigate catabolism, preserve lean body mass, and support immune and organ function. In acute liver failure (ALF), early nutritional intervention within 24–48 h and individualized energy–protein prescriptions are essential, even in the presence of hepatic encephalopathy. Chronic liver failure (CLF) and acute-on-chronic liver failure (ACLF) are often associated with severe malnutrition, sarcopenia, and systemic inflammation, necessitating tailored nutritional strategies. Subjective Global Assessment (SGA) and Royal Free Hospital Global Assessment (RFH-GA) tools are instrumental in identifying nutritional risk. Enteral nutrition (EN) is preferred across all stages, with parenteral nutrition (PN) reserved for contraindications. Special considerations include micronutrient repletion, prevention of refeeding syndrome, and perioperative nutritional support in transplant candidates and recipients. This clinical overview summarizes current evidence and guidelines on ICU nutrition in liver failure, emphasizing a multidisciplinary approach to improve outcomes.