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Acute liver failure induced by idiosyncratic reaction to drugs: Challenges in diagnosis and therapy.
- Source :
-
Liver international : official journal of the International Association for the Study of the Liver [Liver Int] 2018 Jan; Vol. 38 (1), pp. 6-14. Date of Electronic Publication: 2017 Sep 18. - Publication Year :
- 2018
-
Abstract
- Acute liver failure (ALF) requires urgent attention to identify etiology and determine prognosis, in order to assess likelihood of survival or need for transplantation. Identifying idiosyncratic drug-induced liver injury (iDILI) may be particularly difficult, but the illness generally follows a subacute course, allowing time to assess outcome and find a liver graft if needed. Not all drugs that cause iDILI lead to ALF; the most common are antibiotics including anti-tuberculous medications, non-steroidal anti-inflammatory agents and herbal and dietary supplements (HDS). Determining causality remains challenging particularly if altered mentation is present; identifying the causative agent depends in part on knowing the propensity of the drugs that have been taken in the proper time interval, plus excluding other causes. In general, iDILI that reaches the threshold of ALF will more often than not require transplantation, since survival without transplant is around 25%. Treatment consists of withdrawal of the presumed offending medication, consideration of N-acetylcysteine (NAC), as well as intensive care. Corticosteroids have not proven useful except perhaps in instances of apparent autoimmune hepatitis caused by a limited number of agents. Recently developed prognostic scoring systems may also aid in predicting outcome in this setting.<br /> (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Subjects :
- Chemical and Drug Induced Liver Injury diagnosis
Chemical and Drug Induced Liver Injury mortality
Chemical and Drug Induced Liver Injury therapy
Humans
Liver Failure, Acute diagnosis
Liver Failure, Acute mortality
Liver Failure, Acute therapy
Predictive Value of Tests
Prognosis
Risk Factors
Severity of Illness Index
Chemical and Drug Induced Liver Injury etiology
Liver Failure, Acute chemically induced
Subjects
Details
- Language :
- English
- ISSN :
- 1478-3231
- Volume :
- 38
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Liver international : official journal of the International Association for the Study of the Liver
- Publication Type :
- Academic Journal
- Accession number :
- 28771932
- Full Text :
- https://doi.org/10.1111/liv.13535