• Alcohol abuse, or history of alcohol abuse

  • Liver disease (history of disease or persistently high liver enzymes)

  • Electrolyte imbalance or metabolic enzyme deficiencies

  • Thyroid problems 

  • Severe infection

  • Low blood pressure (hypotension)

  • Organ transplant (e.g. heart transplant)

  • Recent major surgery (e.g. open-heart surgery) or trauma