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Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test

Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test

In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess the...

Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow

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Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug binding...

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In pharmacotherapy, monitoring drug concentrations is paramount, especially for drugs whose therapeutic effects hinge on both the active compound and its metabolite. Hepatic impairment profoundly influences drug potency by altering liver function. If the drug is more potent than its metabolite, impaired liver function amplifies drug activity due to elevated drug concentration levels. Conversely, if the metabolite holds greater potency, diminished liver function diminishes drug activity by...

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Related Experiment Video

Updated: May 28, 2026

Endotoxin Activity Assay for the Detection of Whole Blood Endotoxemia in Critically Ill Patients

Endotoxin Activity Assay for the Detection of Whole Blood Endotoxemia in Critically Ill Patients

Published on: June 24, 2019

Initial lactate level and mortality in septic shock patients with hepatic dysfunction.

Y R Kang¹, S W Um, W J Koh

¹Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

Anaesthesia and Intensive Care

|October 6, 2011

Summary

Initial high serum lactate levels predict mortality in septic shock patients, even with liver dysfunction. This finding helps assess patient outcomes regardless of hepatic impairment.

Related Experiment Videos

Last Updated: May 28, 2026

Endotoxin Activity Assay for the Detection of Whole Blood Endotoxemia in Critically Ill Patients

Endotoxin Activity Assay for the Detection of Whole Blood Endotoxemia in Critically Ill Patients

Published on: June 24, 2019

Area of Science:

Critical Care Medicine
Biochemistry
Clinical Pathology

Background:

Elevated serum lactate is linked to mortality in severe sepsis and septic shock.
Hepatic dysfunction complicates lactate interpretation due to impaired clearance or overproduction.
The prognostic value of initial lactate in septic shock with hepatic dysfunction requires clarification.

Purpose of the Study:

To determine if initial serum lactate levels predict mortality in septic shock patients with hepatic dysfunction.
To assess the utility of lactate as a prognostic marker irrespective of liver function.

Main Methods:

Retrospective observational study of 307 septic shock patients admitted to the ICU.
Hepatic dysfunction defined as serum total bilirubin > 34.2 micromol/l (2 mg/dl).
Patients categorized into high (>= 4 mmol/l) and low (< 4 mmol/l) initial lactate groups.

Main Results:

118 patients had hepatic dysfunction.
Initial serum lactate was strongly associated with in-hospital mortality (univariate analysis, P < 0.001).
Lactate remained a significant predictor of mortality after adjusting for confounders (OR 1.281, P = 0.002).

Conclusions:

Initial serum lactate levels are valuable for predicting outcomes in septic shock patients.
Lactate's prognostic utility persists even in the presence of hepatic dysfunction.