The etiology of malnutrition and the metabolic effect of aggressive nutritional support by enteral feeding were evaluated in patients with moderately severe alcoholic hepatitis. Among 21 patients presenting with jaundice, ascites, coagulopathy and low grade encephalopathy, the mean digestibilities (intakefecal excretion/intake x 100) of total energy and fat were subnormal at 74.6 f 2.9 and 64.5 2 4.476, respectively, and nitrogen balance was negative in half the patients with a mean value of +0.74 gm per day f 1.2. Based on initial ad libitum intake of hospital diet, patients were grouped as six patients with adequate caloric intake who underwent a repeated 3-day balance study to assess the effect of hospitalization (Group I) and eight anorectic patients who underwent a repeat balance study during constant nasoduodenal infusion of the liquid formula Isocal-HCN in an amount sufficient to provide 35 kcal per kg ideal body weight (Group 11). During the initial phase of hospital tray diet, the mean digestibilities of energy, fat, protein and carbohydrate, and the mean nitrogen balance were similar in each group. The digestibilities of each diet constituent and nitrogen balance were similar in both phases of hospital tray diet in patients in Group I. On the other hand, the infusion of Isocal-HCN to patients in Group I1 resulted in significant increases over their baseline values in intakes of energy and protein and in digestibilities of energy, fat and protein, and in a &fold increase in nitrogen balance. Provision of essential nutrients by enteric infusion had no effect on fluid balance or degree of encephalopathy. These shortterm studies provide a metabolic basis for enteric formula feeding in improving the intestinal absorption and nitrogen balance of anorectic patients with alcoholic hepatitis.
Alcoholic hepatitis is an acute inflammation of the liver that occurs in chronic alcohol abusers and is commonly associated with multiple signs of malnutrition. Frequent signs of malnutrition in patients with this disease include muscle wasting, the combined anemia of iron and folate deficiency and the neurological manifestations of thiamine deficiency (1). A recent extensive