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Drug therapies in liver disease

Benjamin Faber and Fey Probst
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DOI: https://doi.org/10.7861/clinmedicine.14-2-214
Clin Med April 2014
Benjamin Faber
AEmergency Department, Charing Cross Hosptial, London, UK
Roles: Foundation year 2 doctor
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Fey Probst
BEmergency Department, Charing Cross Hosptial, London, UK
Roles: Consultant
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Editor – We very much enjoyed your article “Drug therapies in liver disease’ (Clin Med December 2013 pp 585–91). As emergency physicians it was a very useful summary; however, we did think there was one very useful drug missing – indomethacin. Hepatic encephalopathy is a complex manifestation of severe liver disease. The article clearly summarises the drugs used to try and decrease the amount of ammonia reaching the cerebral circulation, but does not mention those mitigating cerebral hyperaemia.

Cerebral hyperaemia is associated with high-grade encephalopathy, especially in the acute setting. Indomethacin has been shown to be an effective treatment of hepatic encephalopathy where this is the case and other treatments have failed.1 Therefore, we felt that it deserved a mention in your article given our positive experiences with it.

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  • Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk

  • © 2014 Royal College of Physicians

Reference

  1. ↵
    1. Bernal W,
    2. Wendon J
    . Acute liver failure. N Engl J Med 2013;369:2525–34.doi:10.1056/NEJMra1208937
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Drug therapies in liver disease
Benjamin Faber, Fey Probst
Clinical Medicine Apr 2014, 14 (2) 214; DOI: 10.7861/clinmedicine.14-2-214

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Drug therapies in liver disease
Benjamin Faber, Fey Probst
Clinical Medicine Apr 2014, 14 (2) 214; DOI: 10.7861/clinmedicine.14-2-214
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