Liver or Let Die: The Best and Worst Meds for the Sick Cirrhotic

Patients with decompensated cirrhosis can present with a variety of life-threatening illnesses that require a specialized armamentarium to stabilize and treat their acute condition. Cirrhosis causes multiple downstream modifications to the anatomy and physiology of several organ systems. As a result, many of our go-to meds in the emergency room can worsen the clinical status of a sick cirrhotic whether it’s normal saline, NSAIDS, or narcotics. Many “liver emergencies” - such as hepatic encephalopathy or spontaneous bacterial peritonitis or variceal bleeds - have targeted medications that are infrequently used in the ER but are vital to turning around these patients.