Should protein be restricted in patients with liver failure and encephalopathy?

No. Protein restriction in hepatic encephalopathy is an outdated practice. Current ESPEN/ISHEN guidelines recommend standard protein intake (1.2–1.5 g/kg/day) with branched-chain amino acid supplementation if tolerated. Protein restriction leads to muscle catabolism and worsens outcomes.

How much protein is lost during CRRT and does it need to be replaced?

CRRT removes 5–12 g of amino acids per liter of effluent, typically 10–15 g/day total. Protein targets should be increased to 1.7–2.5 g/kg/day to compensate for CRRT losses and prevent net negative nitrogen balance in AKI patients on renal replacement therapy.

ICU Protein Target Calculator

Calculates protein targets for critically ill patients. Standard critically ill: 1.2–2 g/kg/day. Burns >20% BSA or major trauma: 2–2.5 g/kg/day. Severe AKI not on RRT: may reduce to 0.8–1.0 g/kg to reduce BUN. CRRT: increase to 1.5–2.5 g/kg to replace dialysis losses. Hepatic encephalopathy: not a reason to restrict protein — use 1.2–1.5 g/kg standard amino acids.

⚕ Clinical Disclaimer: These calculators are for educational and reference purposes only. Always verify results with qualified clinical judgment and current clinical guidelines. Do not use as a sole basis for medical decisions.

How to Use

Enter the values for the scenario you are assessing. Calculates protein targets for critically ill patients. Standard critically ill: 1.2–2 g/kg/day. Burns >20% BSA or major trauma: 2–2.5 g/kg/day. Severe AKI not on RRT: may reduce to 0.8–1.0 g/kg to reduce BUN. CRRT: increase to 1.5–2.5 g/kg to replace dialysis losses. Hepatic encephalopathy: not a reason to restrict protein — use 1.2–1.5 g/kg standard amino acids. Use the icu protein targets result to inform your calculation.

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