Hepatic Precoma And Coma

Hepatic precoma and coma may occur in the following liver disorders:

(1) Viral hepatitis.

(2) Cirrhosis of the liver and

(3) Surgery of the liver for various disorders.

The condition is characterised by disordered consciousness, confusion and tremor of the outstretched hands. The possible causes are toxic effects of metabolic products of protein metabolism such as ammonium, indole, skatole, phenols which are not detoxified by damaged liver.

Dietary Management

The requirements for various dietary essentials are briefly discussed below:


The minimum calorie intake should be about 1000 kcal and this should be in the form of glucose, sucrose and fruit juices.


Since nitrogenous products of protein metabolism appear to cause coma, no protein should be given. The endogenous breakdown of proteins is kept at minimum by high carbohydrate diet which spares proteins. The bacterial breakdown of proteins in the large intestines is inhibited by giving antibiotics. When the patient recovers from coma, proteins can be given at low levels (30-40 g/day).


Fats are first metabolised in the liver, fat should not be given in this condition.


The carbohydrates should be readily assimilable and hence should consist of glucose. Glucose is utilized by the tissues even when liver is badly damaged.


The daily requirements of vitamins should be dissolved in the glucose-fruit juice mixture.


The serum of sodium and potassium should be determined and any imbalance corrected by adding salts to the liquid diet. The feeds will have to be given parenterally or through nasogastric tube.

Parenteral Feeding:

If parenteral feeding becomes essential, an intravenous infusion of 2000-2500 ml of 10 percent glucose should be given at the rate of about 30 drops per minute. Vitamins of the B-group, vitamin C and vitamin K are also administered parenterally.

Nasogastric Tube Feeding:

In most of the cases nosogastric tube-feeding is carried out. The feed can be prepared as follows:

Orange juice1000 ml
Glucose200 g
Water1000 ml
Total volume2000ml

The daily requirements of vitamins can be dissolved in the above fluid. The feed should be given in 10 doses of 200 ml each at intervals of 2 hours, starting from 6 AM to 12 midnight.