Liver disease is common. It may be the reason for admission to the intensive care unit (ICU), for example after a paracetamol overdose. Alternatively, it may develop in the ICU, complicating another illness such as sepsis. Finally, patients may have a chronic disease complicated by another illness or an acute exacerbation.

There are several problems caused by hepatic failure which will influence the use of drugs ( Fig 1).

Fig. 1 Some of the many factors affecting pharmacodynamics and pharmacokinetics in liver failure.

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