Drug-Induced Hepatotoxicity
- PMID: 32491467
- Bookshelf ID: NBK557535
Drug-Induced Hepatotoxicity
Excerpt
Drug-induced hepatotoxicity or drug-induced liver injury (DILI) is an acute or chronic response to a natural or manufactured compound. DILI can be classified based on clinical presentation (hepatocellular, cholestatic, or mixed), mechanism of hepatotoxicity, or histological appearance from a liver biopsy. The true incidence is difficult to estimate, yet it has become the leading cause of acute liver failure (ALF) in the United States. The 2 mechanisms of hepatotoxicity are intrinsic, dose-dependent, and idiosyncratic, which is more unpredictable. Most cases of DILI are asymptomatic; however, the most common sign is jaundice. Laboratory tests in hepatocellular injury will have elevation in aminotransferases, while in cholestatic injury, alkaline phosphatase (ALP) is elevated. A liver biopsy is not mandatory for diagnosis but could exclude other causes of liver disease. Treatment begins with the removal of the offending agent, and the prognosis for recovery is usually favorable after discontinuation of the drug.
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Sections
- Continuing Education Activity
- Introduction
- Etiology
- Epidemiology
- Pathophysiology
- Histopathology
- History and Physical
- Evaluation
- Treatment / Management
- Differential Diagnosis
- Pertinent Studies and Ongoing Trials
- Prognosis
- Complications
- Deterrence and Patient Education
- Enhancing Healthcare Team Outcomes
- Review Questions
- References
References
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- Fisher K, Vuppalanchi R, Saxena R. Drug-Induced Liver Injury. Arch Pathol Lab Med. 2015 Jul;139(7):876-87. - PubMed
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- Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, Reddy KR, Watkins PB, Navarro V, Barnhart H, Gu J, Serrano J, United States Drug Induced Liver Injury Network Features and Outcomes of 899 Patients With Drug-Induced Liver Injury: The DILIN Prospective Study. Gastroenterology. 2015 Jun;148(7):1340-52.e7. - PMC - PubMed
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- Chalasani NP, Hayashi PH, Bonkovsky HL, Navarro VJ, Lee WM, Fontana RJ, Practice Parameters Committee of the American College of Gastroenterology ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol. 2014 Jul;109(7):950-66; quiz 967. - PubMed
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