Table 2: Nutritional recommendations for the management of HE in end-stage liver failure.

SubstrateRecommendation

Energy35–40 kcal/kg/day
Protein1.2–1.5 g/kg of body weight/day
BCAAIn severely protein-intolerant patients
Antioxidant and vitaminsMultivitamin supplements
Probiotics, prebioticsIncreasing use for ammonia-lowering and anti-inflammatory actions

In severely protein intolerant patients, protein may be reduced for short periods of time, particularly in grade III-IV hepatic encephalopathy.