ENERGY-METABOLISM IN ACUTE HEPATIC-FAILURE

Background: Conflicting data are available concerning energy metabolism in liver disease. Changes should be most pronounced in acute hepatic failure in which loss of 85% of liver cell mass is reported. Metabolic rate could be decreased due to impairment in liver mass but may also be increased as a result of systemic-mediator actions. To clarify this issue we studied energy metabolism in acute hepatic failure. Methods: Energy metabolism was evaluated by indirect calorimetry in 12 patients with acute liver failure and 22 sex-, age-, and body size-matched healthy individuals. In controls and 5 patients, studies were performed in the postabsorptive state; the remaining 7 patients received glucose at a rate of 8 μmol/kg body weight · min to prevent hypoglycemia. Results: Resting energy expenditure was increased in acute liver failure compared with healthy controls (5.1 ± 0.14 kJ·min-1·1.73 m-2 vs. 3.97 ± 0.08 kJ·min-1·1.73 m-2; mean ± SEM; P < 0.001). Respiratory quotient and oxidation rates for major fuels were not different between the total patientgroup and controls. In patients without glucose supply, energy derived from fat was higher and from carbohydrate lower than in healthy controls and patients with glucose supply. Conclusions: Energy expenditure is increased in acute liver failure. Altered substrate oxidation can be normalized by glucose supply. © 1992.