Toxic Hepatitis

Aka: Toxic Hepatitis, Drug-Induced Hepatitis, Drug Induced Liver Injury

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II. Types: Direct Hepatotoxins (Onset within 48 hours)

  1. Signs
    1. Biopsy with necrosis at terminal hepatic venule
  2. Causes
    1. See Hepatotoxin
    2. Carbon tetrachloride
    3. Benzene derivative
    4. Mushroom Poisoning
    5. Herbal Toxicity
    6. Antiepileptics
    7. Amiodarone
    8. Methotrexate
    9. Acetaminophen (42% of acute liver injury in U.S.)
      1. See Acetaminophen Toxicity
    10. Antibiotics (second most common cause in U.S.)
      1. Amoxicillin-clavulanate
      2. Trimethoprim-sulfamethoxazole
      3. Isoniazid
      4. Nitrofurantoin

III. Types: Idiosyncratic Reaction (Variable onset)

  1. Signs
    1. Fever
    2. Rash
    3. Arthralgia
    4. Eosinophilia
  2. Causes
    1. Isoniazid
    2. Halothane
    3. Phenytoin
    4. Methyldopa

IV. Resources

  1. See Hepatotoxin
  2. NIDDK/NLM Liver Tox
    1. http://www.livertox.nih.gov

V. References

  1. Reuben (2010) Hepatology 52(6): 2065-76 [PubMed]

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