Impaired liver function as presented in cirrhosis, acute-on-chronic liver failure (ACLF), acute liver failure (ALF), or other hepatopathies, can result in multiple organ failure and frequently requires intensive care unit (ICU) treatment. The treatment of critical ill patients with liver disease poses a particular challenge in the clinical daily routine. These patients have an elevated risk for malnutrition and sarcopenia associated with an increased mortality rate. Detailed nutritional assessment can help to counteract possible nutritional deficiencies and address individual needs. Medical nutritional therapy in ICU patients with liver disease shares similarities with the general ICU population while certain specific aspects must be considered, which are addressed in this chapter.