Management strategies

In many patients the identification of specific etiological factors will dictate the appropriate therapeutic strategy. Where possible, drugs, antibiotics, and anesthetic agents with a lower incidence of hepatotoxic side-effects should be used. The hepatic metabolism of many drugs is profoundly altered during critical illness and positive-pressure ventilation, with changes in volume of distribution, protein binding, and plasma clearance by the kidney or liver. Hepatic abnormalities due to total parenteral nutrition can be avoided by administering adequate protein and 20 to 50 per cent of non-protein calories as fat. Cyclical administration of total parenteral nutrition and glucose may help to prevent these changes.

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