HLA-DR6 was present in four of five patients (80%) with chlorpromazine hepatitis, compared to 22% in controls. In conclusion, the HLA phenotype does not contribute significantly to idiosyncratic drug-induced hepatitis considered collectively. [ncbi.nlm.nih.gov]

Reaction less dose dependent and more varied in latency, presentation, and course. [utahgastroblog.com]

Younger patients present most commonly with a hepatocellular pattern of injury, whereas older patients mostly present with a cholestatic pattern of liver injury. 3 Some studies have found that women have a greater risk of developing DILI than men. 13 [mdedge.com]

Always consider drugs as a cause of any patient presenting with hepatitis in order to provide early effective management. [patient.info]

Hundreds of brand-new illustrations clearly present key aspects of liver disease. [books.google.de]

• Sepsis

  Abstract Favorites PDF Get Content & Permissions Open Predictive accuracy of Sepsis-3 definitions for mortality among adult critically ill patients with suspected infection Chen, Qi-Hong; Shao, Jun; Liu, Wei-Li; More Chinese Medical Journal. 132(10):1147 [cmj.org]

  Rule out infectious (i.e., viral hepatitis, cholangitis, sepsis, hepatic abscess), ischemic (i.e., shock, thromboembolic disease), metabolic (i.e., iron, copper overload, fatty liver/steatohepatitis), and autoimmune causes (i.e., autoimmune hepatitis, [clinicaladvisor.com]

  […] competing disorders (e.g., sarcoidosis, sickle cell-related biliary stone disease, oriental sclerosing cholangitis) Indication for use of drug or herbal or dietary supplement (HDS) Concomitant diseases – Particularly pertinent disorders may include sepsis [utahgastroblog.com]

  Often, cholestasis in such neonates is multifactorial, contributed to by other factors such as sepsis, hypoxemia, and hypotension; occasionally, TPN-induced cholestasis in neonates culminates in chronic liver disease and liver failure. [clinicalgate.com]

  However, various intrahepatic etiologies mimicking DILI must be excluded based on careful history and physical examination (sepsis, total parenteral nutrition, or heart failure), serological testing (anti-mitochondrial antibody for primary biliary cirrhosis [gi.org]

• Malaise

  These incidents usually occur during the first 6 months of treatment and are preceded by nonspecific symptoms such as malaise, weakness, lethargy, facial edema, anorexia, vomiting, and even loss of seizure control. [emedicine.medscape.com]

  Initially, anorexia, nausea, and malaise may occur, followed by pruritus in some but not all patients. [clinicalgate.com]

• Hypoxemia

  Often, cholestasis in such neonates is multifactorial, contributed to by other factors such as sepsis, hypoxemia, and hypotension; occasionally, TPN-induced cholestasis in neonates culminates in chronic liver disease and liver failure. [clinicalgate.com]

• Skin Lesion

  Distinguishing between the various types of skin lesions is important, because this may provide substantial clues to the possible immune-mediated mechanism of the drug reaction ( Table 5 ). [aafp.org]

• Dark Urine

  Some of the common symptoms are: nausea vomiting headache anorexia jaundice clay color stools dark urine hepatomegaly Diagnosis Diagnosis is typically made through a physical exam along with a patient history to identify any possible hepatotoxins. [medical-dictionary.thefreedictionary.com]

  urine Diarrhea Fatigue Fever Headache Jaundice Loss of appetite Nausea and vomiting Rash White or clay-colored stools Exams and Tests You will have blood tests to check liver function. [mountsinai.org]

  Patients should be advised to promptly report any new onset symptoms such as yellowing of their eyes, abdominal pain / discomfort, nausea / vomiting, itching, or dark urine. [utahgastroblog.com]

  Later, overt evidence of liver damage, such as jaundice, dark urine and an enlarged and tender liver, may develop. Two general pathogenic mechanisms are recognised: Predictable or direct: usually promptly follows an exposure to a new medication. [patient.info]

  Symptoms of liver damage include 5, 18 : Dark Urine. Fever. Pain in the abdomen. Nausea. Vomiting. Headache. Diarrhea. White stools. Rash. Build-up of fluid in the abdominal cavity. Jaundice (yellowing of eyes and skin). Enlarged liver. Fatigue. [drugabuse.com]

[…] cardiovascular causes, especially right-sided heart failure Cholecystitis Cholangitis Budd-Chiari syndrome Alcoholic liver disease Cholestatic liver disease Pregnancy-related conditions of liver Malignancy Wilson disease Hemochromatosis Coagulation disorders Workup [emedicine.medscape.com]

[…] liver injury, and changes in hepatitis C virus treatment and hot-button concerns about access to care. [books.google.de]

treatments 19-73 days (median 28). [journals.plos.org]

A viral hepatitis was excluded and valproic acid treatment was stopped. Upon normalisation of the liver tests, temozolomide treatment was resumed without perturbation of the liver tests. [scholars.northwestern.edu]

Prognosis Usually the symptoms will go away after the drug has been eliminated due to the liver repairing itself. A full recovery is typically expected unless it wasn't treated quickly resulting in more liver damage being done than normal. [medical-dictionary.thefreedictionary.com]

Outlook (Prognosis) Drug-induced liver injury most often goes away within days or weeks after you stop taking the drug that caused it. Possible Complications Rarely, drug-induced liver injury can lead to liver failure. [mountsinai.org]

The risk is higher in women. [ 6, 7 ] Prognosis Usually symptoms subside when the causative drug has been discontinued and drug-related hepatitis subsides within days or weeks after the offending drug is stopped. [patient.info]

The impact of eosinophilia and hepatic necrosis on prognosis in patients with drug-induced liver injury. Aliment Pharmacol Ther 2007;25:1411–1421. 36. Rochon J, Protiva P, Seeff LB et al. [gi.org]

The dose toxic to the liver is quite variable from person to person and is often thought to be lower in chronic alcoholics. [16] [17] Measurement of blood level is important in assessing prognosis, higher levels predicting a worse prognosis. [en.wikipedia.org]

ICD-10-CM Codes › K00-K95 Diseases of the digestive system › K70-K77 Diseases of liver › Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10data.com]

This categorization allows testing for competing etiologies in a systematic approach. [utahgastroblog.com]

Etiology of newonset jaundice: how often is it caused by idiosyncratic druginduced liver injury in the United States? Am J Gastroenterol 2007;102:558-562. 9. Jinjuvadia K, Kwan W, Fontana RJ. [degruyter.com]

New epidemiologic data suggest that approximately 20 new cases of DILI per 100,000 persons occur each year. Idiosyncratic DILI accounts for 11% of the cases of acute liver failure in the United States. [mayoclinic.pure.elsevier.com]

Epidemiology and individual susceptibility to adverse drug reactions affecting the liver. Semin Liver Dis 2002;22:145-155. 7. Temple RJ, Himmel MH. Safety of newly approved drugs: implications for prescribing. JAMA 2002;287:2273-2275. 8. [degruyter.com]

About 10% of cases are idiosyncratic. [ 1 ] Epidemiology A very large number of drugs have been implicated as a potential cause of drug-induced hepatitis but with variable risk of both frequency and severity. [patient.info]

Epidemiology Adverse drug reactions caused by immune and nonimmune mechanisms are a major cause of morbidity and mortality worldwide. [aafp.org]

Epidemiology and individual susceptibility to adverse drug reactions affecting the liver. Seminars Liver Dis., 22: 145-155. PubMed | Lee, W.M. and W.T. Denton, 1989. [scialert.net]

New to this edition are artwork and figures that illustrate the pathophysiology of many conditions in a full-color format. [books.google.de]

Definition / general Drug / toxin reactions can be intrinsic or predictable, where they are dose dependent (e.g. acetaminophen ); or idiosyncratic and unpredictable, where they are dose independent (e.g. isoniazid) Pathophysiology Underlying mechanisms [pathologyoutlines.com]

The latter are unpredictable and dose-independent and may be related to either toxic or autoimmune pathophysiology. [karger.com]

[…] and mechanisms of drug-induced liver injury Pathophysiologic mechanisms The pathophysiologic mechanisms of hepatotoxicity are still being explored and include both hepatocellular and extracellular mechanisms. [emedicine.medscape.com]

[…] icon highlights health promotion and disease prevention information.- Elderly tips and Pediatric tips emphasize important variations in these patient populations. [books.google.de]

Monitoring for and recognition of drug-induced hepatotoxicity may prevent some cases of acute hepatic failure. [nejm.org]

Preventing Liver Damage There are many different things you can do in order to prevent liver damage. Be mindful of the following tips 5, 7 : Don’t take more than the recommended dose of acetaminophen or other non-prescription medications. [drugabuse.com]

Hepatitis E Whether IG prevents hepatitis E remains undetermined. [clinicalgate.com]

Prevention If there is a history of liver damage certain medications should not be taken. Doctors will be familiar with these. Resources Books Feldman, Sleisenger, and Scharschmidt. "Liver Diseases Caused by Drugs, Anesthetics, and Toxins." [medical-dictionary.thefreedictionary.com]