How would you diagnose a case of drug-induced liver injury?

How would you diagnose a case of drug-induced liver injury?

The diagnosis of liver disease is based on a patient’s symptoms (such as loss of appetite, nausea, fatigue, itching, and dark urine), findings on the physical examination (such as jaundice, enlarged liver), and abnormal laboratory tests (such as blood levels of liver enzymes or bilirubin and blood clotting times).

Is drug-induced liver injury rare?

Although drug-induced liver injury (DILI) is a rare clinical event, it carries significant morbidity and mortality, leaving it as the leading cause of acute liver failure (ALF) in the United States. It is one of the most challenging diagnoses encountered by gastroenterologists.

What is Hy’s Law criteria?

Biochemical criteria for Hy’s Law were defined as an alanine aminotransferase or aspartate aminotransferase ≥3 times upper limit of normal and a total bilirubin ≥2 times upper limit of normal on or prior to the date a drug-induced liver injury diagnosis was recorded.

Is medication induced liver damage reversible?

While PBC may result in end-stage liver disease (ESLD) and death, chronic cholestasis caused by medications is usually reversible and considered benign. Some forms of chronic medication-induced cholestasis are associated with destruction of the intra-hepatic bile ducts.

How long does it take liver enzymes to return to normal after stopping medication?

Serum enzymes improve rapidly (within 2 to 4 weeks) of stopping the medication, but also may improve spontaneously even with continuation of drug (which is sometimes referred to as “adaption”).

What percentage of Hy’s law cases turn to acute liver failure?

According to Hy’s law drug-induced jaundice caused by a hepatocellular injury, leads to death from liver failure or need for a liver transplantation in approximately 10% of cases (2,3).

How is liver toxicity measured?

The ALT and AST tests measure enzymes that your liver releases in response to damage or disease. The albumin test measures how well the liver creates albumin, while the bilirubin test measures how well it disposes of bilirubin. ALP can be used to evaluate the bile duct system of the liver.

What is the incidence of drug-induced liver injury (DILI)?

The incidence of drug induced liver injury (DILI) is about 1/1000 to 1/10000 among patients who receive therapeutic drug doses. Drug induced hepatotoxicity is a major cause of acute and chronic liver disease. The severity of liver damage ranges from nonspecific changes in liver structure to acute liver failure, cirrhosis and liver cancer.

How does the liver respond to drug-induced liver injury?

The liver has a range of responses to drug-induced injury, with a number of phenotypes. In addition, idiosyncratic reactions may occur as a consequence of both direct drug action and indirect drug effects. Antibiotics are the most common cause of drug-induced liver injury.

Do antibiotics cause drug-induced liver damage?

Antibiotics are the most common cause of drug-induced liver injury. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. No potential conflict of interest relevant to this article was reported. We thank Drs. Paul Watkins and James Knoben for their advice and insights.

How is drug-induced hepatotoxicity categorized?

Drug-induced hepatotoxicity can be categorized based on the pattern of liver enzyme alteration (hepatocellular, cholestatic or mixed pattern), the mechanism of hepatotoxicity (direct, immune mediated or idiosyncratic) and histologic findings on liver biopsy (steatosis or sinusoidal obstruction syndrome).