PHARMACOLOGY DEPARTMENT Clinical Pharmacy

Universitas Muslim Indonesia

Monitoring Patients With Liver Disease

HENDRA HERMAN

Makassar, May 31st 2015

PHARMACOLOGY DEPARTMENT Clinical Pharmacy
Universitas Muslim Indonesia

Liver Function
Control of synthesis and metabolism of MOST PROTEINS and
COAGULATION FACTORS, CARBHYDRATE & LIPIDS.
The site of DRUG METABOLISM
CONVERTING EXCESS CARBOHYDRATES AND PROTEINS into FATTY
ACIDS and TG.
Stored and Convert GLYCOGEN GLUCOSE
Metabolism and excretion of BILIRUBIN and BILE ACIDS

Makassar, May 31st 2015

PHARMACOLOGY DEPARTMENT Clinical Pharmacy
Universitas Muslim Indonesia

Acute Liver disease Symptoms

Lethargy
Anorexia
Malaise and jaundice
But can present asymptomatically

Makassar, May 31st 2015

PHARMACOLOGY DEPARTMENT Clinical Pharmacy
Universitas Muslim Indonesia

Chronic Liver disease Symptoms

Late presentation
Ascites
Haematemesis
Melaena
Confusion
drowsiness

Makassar, May 31st 2015

PHARMACOLOGY DEPARTMENT Clinical Pharmacy
Universitas Muslim Indonesia

Laboratory
Category Normal Critical Note

ALT/SGPT 10-35 IU/L 2 3 x 35 ALT>AST= acute

AST>ALT =
alcoholic hepatitis
Bilirubin total 0.3- 1 mg/dL Adult >12, Cirrhosis
newborn >15
Alkaline PO4 44-147 IU/L ND Not specific
(ALP)
PT 11-15 sec >30 sec Bleeding >>

Albumin 3.5-5.5 g/dL ND Estrogen dpt

meningkatkan;
Chronic Liver
Disease

Makassar, May 31st 2015

PHARMACOLOGY DEPARTMENT Clinical Pharmacy
Universitas Muslim Indonesia

Assesment of Liver Function

Child-Pugh Score
Component Score
1 2 3
Encephalopathy None 1-2 3-4

Grade 1 = konfusi ringan, cemas, gelisah, tremor ringan, koordinasi lambat

Grade 2 = drowsiness, disorientasi, asterixis
Grade 3 = somnolent, konfusi, bicara tidak nyambung, incontinent,
hyperventilation
Grade 4 = coma

Makassar, May 31st 2015

PHARMACOLOGY DEPARTMENT Clinical Pharmacy
Universitas Muslim Indonesia

Assesment of Liver Function

Child-Pugh Score
Component Score
1 2 3
Encephalopathy None 1-2 3-4

Ascites None Mid or controlled Moderate or

by Diuretics refractory despite
diuretics

Albumin >3.5 2.8-3.5 <2.8

Bilirubin total <2 (<34 2-3 (34-50 >3 (>50
(mg/dL) micromoles/L) micromoles/L) micromoles/L)

PT (second <4 4-7 >7

prolonged)
Makassar, May 31st 2015
PHARMACOLOGY DEPARTMENT Clinical Pharmacy
Universitas Muslim Indonesia

Assesment of Liver Function

Alternative Child-Pugh Score
Component Score
1 2 3
Encephalopathy None 1-2 3-4

Ascites None Mid or controlled Moderate or

by Diuretics refractory despite
diuretics

Albumin >3.5 2.8-3.5 <2.8

Bilirubin total <2 (<34 2-3 (34-50 >3 (>50
(mg/dL) micromoles/L) micromoles/L) micromoles/L)

INR <1.7 1.7-2.3 >2.3

Makassar, May 31st 2015

PHARMACOLOGY DEPARTMENT Clinical Pharmacy
Universitas Muslim Indonesia

Assesment of Liver Function

CPH Classification

Class A (mild hepatic impairment): Score 5-6

Class B (Moderate) : Score 7-9
Class C (Severe) : Score 10-15

Makassar, May 31st 2015

PHARMACOLOGY DEPARTMENT Clinical Pharmacy
Universitas Muslim Indonesia

Pustaka Penunjang

Drugs And the Liver, 2008, Penny North-Lewis

DIH

Makassar, May 31st 2015

PHARMACOLOGY DEPARTMENT Clinical Pharmacy
Universitas Muslim Indonesia

Makassar, May 31st 2015