Metadoxine is not effective in improvement of liver histology or serum ALT or AST in patients with NASH. However, there was significant improvement of steatosis assessed by ultrasound. To properly estimate the effects on histology and transaminases, further studies of longer duration and at higher doses are needed.

Terlipressin is a commonly used drug in hepatology practice for the two most serious complications of cirrhosis, that is, acute oesophageal variceal bleed and hepatorenal syndrome. Acute-on-chronic liver failure (ACLF) is a medical emergency and is frequently associated with acute kidney injury (AKI). Two male patients with alcohol-induced ACLF with high MELD (Model for End-Stage Liver Disease) score presented with AKI. Both were treated with terlipressin infusion. There was no response to terlipressin in these sick patients, and further both patients developed ischaemic skin necrosis and succumbed to multiorgan failure. Continuous infusion of terlipressin is superior to bolus dosing, but we noted that continuous infusion might as well be associated with severe adverse effects in patients with a high MELD score. More extensive prospective studies, including patients with high MELD score, are required to ascertain the safety of terlipressin.

Antioxidant drugs form one of the mainstay therapies for pain management in chronic pancreatitis. Heightened oxidative stress and free radical activity is the target for the use of antioxidant therapy in chronic pancreatitis pain relief. One of the chief components of these drugs is beta-carotene, and vitamin A. Vitamin A is a proven hepatotoxic agent which can lead to liver injury ranging from acute hepatitis to cirrhosis. Here, we present a case of chronic pancreatitis who continued antioxidant therapy unsupervised for 7 years and developed vitamin A-induced acute liver failure, which was treated with prednisolone.