Toxic Acute Liver Failure

Abstract

Although rare, drug-induced liver injury (DILI) accounts for up to 10 percent of all adverse drug reactions. The majority of patients will recover following withdrawal of the offending agent. However, in some cases DILI can be fatal. The liver is exposed to nearly all drugs absorbed from the intestinal tract and is the predominant site of drug metabolism. Reactive drug metabolites, genetic susceptibility, and environmental factors all appear to play a role in development of DILI. Idiosyncratic hepatotoxicity is the most common type of DILI seen, accounting for >90 to 95 percent of cases. However, our understanding of the pathogenesis of drug induced liver injury remains in its infancy. A searchable database of drugs, herbal medications, and dietary supplements has been developed by the National Institutes of Health. DILI can be classified in several ways, including by its clinical presentation (hepatocellular injury, cholestatic injury, or mixed injury).