Clinical Case Database / Category: Clinical Care

Drug treatment of liver disease

Publication details

Alastair O'Brien, Bsc, MBBS, MRCP, PhD, Professor Roger Williams, CBE, MD, FRCP, FRCS, FRCPE, FRACP, FMedSci, FRCPI (Hon), FACP (Hon)
Foundation Years Journal, volume 5, issue 8, p.20 (123Doc Education, London, September 2011)


A 55 year old man presents to A&E feeling unwell and is found to have fast atrial fibrillation and aspiration pneumonia. Upon taking a history you find that he has a heavy history of alcohol consumption throughout his adult life. On examination you find that he is icteric, spider naevi are present and he has ascites. His blood tests show a platelet count of 105, INR 1.4, Albumin 32, bilirubin 65, ALT 40, Alk Phos 105. This article will help you decide on the most appropriate treatment, dosing regimen, monitoring and possible adverse events in the management of this patient.

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Alastair O'Brien, Bsc, MBBS, MRCP, PhD

Clinical Senior Lecturer and Honorary Consultant in Hepatology,
University College London Medical School,
University College Hospital and
The Royal Free Hospital NHS Trust

Professor Roger Williams, CBE, MD, FRCP, FRCS, FRCPE, FRACP, FMedSci, FRCPI (Hon), FACP (Hon)

Institute of Hepatology London
Foundation for Liver Research
69-75 Chenies Mews,
London WC1E 6HX


1. Delco, F., Tchbaz, L., Schlienger, R. Drewe, J, Krahenbuhl, S. (2005). Dose adjustment in patients with liver disease. Drug Safety; 28: 529-45.
2. Lee, W. M. (2003). Drug-Induced Hepatotoxicity, N. Engl. J. Med. 349: 474-85.
3. Lewis J.H. (2002). Expert Opinion on Drug Safety, Vol 1, No. 2, pp. 159-172(14). Informa Healthcare.
4. Pirmohamed, M. (2007). Prescribing in liver disease, Medicine 35: 1, 31-4.


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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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