Patients in hepatic coma may have metabolic disorders of sugar, fat, protein and electrolytes. 1. Disorders of sugar metabolism: The enzymes in the normal liver enable the breakdown of liver glycogen to maintain blood glucose concentration with sufficient glucose. In liver failure, the activity of glycogen phosphorylase is affected due to the reduction of liver glycogen reserve, and then the liver’s ability to inactivate insulin is weakened, resulting in the imbalance of pancreatic hormone level, so that patients in liver coma are prone to hypoglycemia. In addition, due to the lack of liver enzymes, glucose metabolites and pyruvate accumulate, resulting in metabolic acidosis. 2, protein and fat metabolism disorders: due to the reduction of liver glycogen, the intracellular sugar metabolism of the liver is weakened, and the body has to supply energy, prompting protein and fat metabolism to strengthen. The excess of protein will have the risk of causing azotemia and ketosis. 3, electrolyte metabolism disorders: patients in hepatic coma often have a large amount of ascites; long-term low sodium diet, vomiting, diarrhea, after repeated use of diuretics and corticosteroids, etc., will cause hyponatremia and hypokalemia. From the perspective of the pathogenesis of hepatic coma, the metabolic disorders of nitrogenous substances are the biochemical basis of hepatic encephalopathy, while the disorders of sugar, fat and electrolytes can aggravate hepatic coma. Therefore, in the nutritional treatment of patients with hepatic coma, strict control of the quality and quantity of protein in the diet is an important aspect, and a high protein diet will often promote or aggravate hepatic coma. Nutritional therapy for hepatic coma The purpose of nutritional therapy is to strictly limit protein intake to reduce ammonia formation and prevent and reduce hepatic coma; to supplement appropriate calories to ensure metabolic needs; and to pay attention to water-electrolyte balance. The specific requirements are to supply low protein, high sugar, adequate vitamins and moderate amount of caloric diet. It should be nutritious, easy to digest and absorb, and the fat content advocates that a salt-free diet is not necessary, as it will affect the appetite but will outweigh the losses. Those with significant liver function impairment or high blood ammonia with a tendency to develop hepatic encephalopathy should temporarily limit protein intake. Alcohol and coarse and sharp foods should be avoided. In the decompensated stage, supportive therapy should be strengthened. For patients with severe disease who have nausea, vomiting, little or no food, intravenous infusion of glucose with vitamin C, potassium chloride, inosine, insulin, etc. Special attention should be paid to maintaining water, electrolyte and acid-base balance, especially to potassium salt supplementation. In addition, compounded amino acids, fresh blood, plasma and clear protein can be applied as appropriate. Nutritional treatment principles for hepatic coma 1.Supply of heat energy: In order to ensure the metabolic needs of the body and reduce autolytic decomposition, the daily supply of heat energy should not be less than 7531kj(1800kcal) 2.Supply of sugar: High sugar should be supplied, about 400g per day, which provides 669kJ(1600kcal) of heat energy. 3, supply fat: should supply low fat, about 30~40g per day, it provides about 1130~1506kJ(270~360kcal) of caloric energy. In order to ensure the supply of heat energy to prevent diarrhea, fat emulsion can be used. 4, give vitamin-rich diet: supply vitamin-rich food, especially vitamin C-rich food. 5.Pay attention to the balance of electrolytes in the diet: according to the condition, the content of sodium and potassium in the diet should be adjusted to help correct the clinical electrolyte disorder. 6, the nature of the meal selection: pre-consciousness, it is appropriate to give very easy to digest less residue semi-liquid or liquid diet, coma can not eat, if there is no esophageal varices, available nasal feeding.