NUTRITIONAL SUPPORT IN HEPATIC-DISEASE .1. METABOLIC ALTERATIONS AND NUTRITIONAL CONSIDERATIONS IN DOGS AND CATS

The therapeutic objectives for the nutritional management of patients with advanced hepatic disease are to help prevent further hepatocyte i njury and provide a favorable environment for the repair and regenerat ion of hepatocytes. Achieving these goals represents a significant cha llenge in the hypoproteinemic patient because a precarious balance exi sts between the need to restore protein intake and the potential risk of precipitating hepatic encephalopathy. To optimize nutritional statu s, dietary protein should not be overly restricted until protein intol erance becomes apparent. The source of protein is important in managin g acute and chronic hepatic insufficiency. Proteins derived from milk or vegetables are superior to meat-derived proteins and help reduce he patic disease and prolong survival. Caloric requirements should be met with carbohydrates and fats to minimize protein catabolism for energy and the concurrent formation of excess ammonia. Metabolic alterations associated with hepatic disease and the nutritional considerations th at correct these disorders are reviewed.