Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Sep 2010
ReviewDrug dosing considerations for the critically ill patient with liver disease.
Hepatic dysfunction in the critically ill patient presents a unique challenge to clinicians when designing pharmacotherapeutic treatment plans. Overall, the literature regarding drug dosing in critically ill patients with hepatic dysfunction is incomplete and current tools available to bedside clinicians have limitations. ⋯ This information can be applied clinically and careful monitoring plans can be implemented to assess a drug for efficacy and safety. This article reviews the pharmacokinetic changes that can occur in hepatic failure, identifies practical ways to quantify the severity of dysfunction, and discusses general drug dosing strategies in this patient population.
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Crit Care Nurs Clin North Am · Sep 2010
ReviewInfectious diseases in end-stage liver disease patients.
Patients with chronic liver diseases sustain impairment to immune systems, which worsens over time. These defects in their host defense lead to risks of bacterial infections and increased morbidity. ⋯ There should be a low threshold for obtaining diagnostic cultures and peritoneal fluid samples and discussing possible causes with an infectious diseases consultant or a microbiology laboratory. These maneuvers will maximize therapy in patients at high risk for death due to infectious disease.