Abstract
The present study was undertaken to investigate hepatocellular and systemic energy metabolism in critically ill patients with liver failure. The arterial ketone body ratio (AKBR), total ketone bodies, pyruvate/lactate, energy expenditure and respiratory quotient were measured in 43 patients with septic hepatic faliure, 16 patients with acute type fulminant hepatitis and 13 patients with subacute type fulminant hepatitis who were treated in the ICU. The results showed that deterioration of metabolism developed in both the liver and the whole body in septic hepatic failure and that metabolic derangement took place only within the liver in fulminant hepatitis. Hepatocellular metabolic dysfunction developed diffusely in the whole liver in acute type fulminant hepatitis, but only in parts of the liver in subacute type fulminant hepatitis. The main energy substrate in septic hepatic failure was fat and in fulminant hepatitis was glucose.
These results suggest that critically ill patients with hepatic failure present a variety of symptoms and metabolic changes and that it is of the utmost importance to measure various metabolic parameters to establish nutritional support based on each patients metabolic changes.
