A patient with alcoholic liver disease may be malnourished and require nutritional supplementation. Nutritional support is associated with improved outcomes. While the enteral route is preferred, parenteral nutrition may become necessary for a number of reasons.
Patient selection: alcoholic liver disease with need for nutritional support
Indications for parenteral nutrition:
(1) non-functioning gastrointestinal tract
(2) intolerance for enteral nutrition (nausea and vomiting, malabsorption, diarrhea)
(3) enteral route unsafe or not feasible
A non-functioning gastrointestinal tract may include
(1) paralytic ileus
(2) small bowel obstruction
(3) postoperative status
The enteral route may be unsafe or not feasible in:
(1) hepatic encephalopathy
(2) altered mental status
(3) acute pancreatitis
(4) gastrointestinal fistulas
(5) risk factors for aspiration (reduced cough reflex, difficulty swallowing)
