Experience with Administration of a Branched-chain Amino Acid- and Carnitine-enriched Enteral Nutrient as a Late Evening Snack in a Patient with Hepatic Cirrhosis

Case Report

J Hepat Res. 2014;1(3): 1015.

Experience with Administration of a Branched-chain Amino Acid- and Carnitine-enriched Enteral Nutrient as a Late Evening Snack in a Patient with Hepatic Cirrhosis

Naoki Hotta*

Department of Internal Medicine, Division of Hepatology, Masuko Memorial Hospital, Japan

*Corresponding author: Naoki Hotta, Department of Internal Medicine, Division of Hepatology, Masuko Memorial Hospital, Aichi, 35-28 Takebashi Nakamuraku, Nagoya, Aichi, 453-8566, Japan

Received: July 30, 2014; Accepted: October 20, 2014; Published: October 22, 2014

Abstract

In nutrition therapy for patients with liver cirrhosis, not only administration of branched-chain amino acid (BCAA)-containing preparations but also lateevening snack (LES) therapy is recommended to prevent the starvation-like state in these patients associated with abnormal energy metabolism in the early morning fasting condition. In the present study, we examined the usefulness of a BCAA- and carnitine-enriched enteral nutrient (ENEVO, Abbott Japan Co., LTD.) as an LES in a patient with liver cirrhosis who refused consumption of another enteral nutrient administered as part of the management of hepatic failure, as it produced abdominal distention.

Keyword: Late evening snack; Branched-chain amino acid- and carnitineenriched enteral nutrient; Hepatic cirrhosis

Case Presentation

Patient

A 61-year-old man

Chief complaints

General malaise and anorexia

Past history

Unremarkable except for alcoholic hepatitis

Present illness

The patient was under regular outpatient follow-up for alcoholic hepatitis. Two weeks before visiting our hospital, he began to experience anorexia and general malaise.

Status at the present visit: Height, 169 cm; weight, 89 kg; body temperature, 36.2°C; pulse, 72/min (regular); clear consciousness; no conjunctival pallor, scleral icterus, or distended cutaneous veins on the abdominal wall; liver and spleen, not palpable; palmar erythema, present; no pedal edema, spider angioma, asterixis, or tremors.

Status at the present visit: Height, 169 cm; weight, 89 kg; body temperature, 36.2°C; pulse, 72/min (regular); clear consciousness; no conjunctival pallor, scleral icterus, or distended cutaneous veins on the abdominal wall; liver and spleen, not palpable; palmar erythema, present; no pedal edema, spider angioma, asterixis, or tremors.

According to the blood test findings on admission, the residual liver function was classified as Child-Pugh grade B, and the BCAAto- tyrosine ratio (BTR) was low at 1.73. The serum free fatty acid level was elevated at 1137.00 uEq/L (Table1).

Citation: Hotta N. Experience with Administration of a Branched-chain Amino Acid- and Carnitine-enriched Enteral Nutrient as a Late Evening Snack in a Patient with Hepatic Cirrhosis. J Hepat Res. 2014;1(3): 1015. ISSN:2381-9057