Controversies in Acute Medicine

A fundamental aspect of managing liver patients in the acute setting is assessing and correcting f luid and nutritional status. The intrinsic abnormalities of salt and water handling in patients with liver dysfunction worsen with disease progression. Additionally, they are further aggravated by the processes that cause decompensation and presentation to hospital e.g. sepsis or haemorrhage. Injudicious use or inadequate use of f luids may create further complications in a patient group with a high mortality and morbidity. We have used a case to help illustrate some of the practical points in managing this group of patients.