Hepatic failure

The incidence of liver disease is increasing in the UK, attributable to a surge in excessive alcohol consumption and obesity. It is therefore not surprising that intensive care units are managing more patients with chronic liver disease. These individuals are often malnourished and can rapidly progress to multi-organ failure, requiring prolonged spells of organ support.However the spectrum of liver dysfunction encountered in the critical care setting is quite diverse and includes patients with:• acute liver failure• decompensation of chronic liver disease and associated complications• impaired liver function secondary to severe systemic illness and its treatment.In this article we describe the aetiology, investigation, management and prognosis of patients presenting to critical care with severe liver impairment. Transplantation has radically modified the outcome for many patients and early specialist referral should be considered.