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Toxic Hepatitis

Overview

Toxic hepatitis is a condition in which your liver becomes inflamed due to exposure to certain toxins. Alcohol, drugs, chemicals, and nutritional supplements can induce toxic hepatitis. Toxic hepatitis can develop hours or days after being exposed to a toxin. In some situations, signs and symptoms may not develop until months after regular use. Toxic hepatitis symptoms usually go away once the toxin is no longer present. Toxic hepatitis, on the other hand, can permanently damage your liver, leading to irreversible scarring of liver tissue (cirrhosis) and, in some cases, life-threatening liver failure.

Causes

Toxic hepatitis develops when your liver becomes inflamed as a result of exposure to a toxic substance. . Most drugs and chemicals are generally removed from the bloodstream and broken down by the liver. Toxins are broken down into byproducts that can damage the liver. Although the liver has a high capacity for regeneration, prolonged exposure to harmful chemicals can result in serious, often irreparable damage.

Toxic hepatitis can be caused by a variety of factors, including:

Alcohol: Heavy drinking over a long period can cause alcoholic hepatitis, which is an inflammation of the liver caused by alcohol and can lead to liver failure.

Medications: Toxic hepatitis can also develop when you take too much of a prescription or over-the-counter medicine. .  The statin drugs used to treat high cholesterol, the combination drug amoxicillin-clavulanate, phenytoin, azathioprine, niacin, ketoconazole, some antivirals, and anabolic steroids are all linked to serious liver injury. Nonprescription pain medications such as acetaminophen, aspirin, ibuprofen, and naproxen might damage your liver if used frequently or in combination with alcohol.

Industrial chemicals: Chemicals that you can be exposed to on the job can also harm your liver. The herbicide paraquat, the dry cleaning solvent carbon tetrachloride, and a group of industrial chemicals known as polychlorinated biphenyls are all examples of substances that can affect the liver.

Supplements and herbs: Aloe vera, black cohosh, cascara, chaparral, comfrey, kava, and ephedra, amongst others, are some of the herbs that are toxic to the liver. If children consume a large number of vitamin pills, mistaking them for sweets may also seriously affect their liver. 

Signs and Symptoms

The following are some of the signs and symptoms of toxic hepatitis:

  • Yellow discoloration of eyes and skin ( Jaundice)
  • Abdominal pain or discomfort (Right upper quadrant)
  • Loss of appetite
  • Itching
  • Fatigue or weakness
  • Nausea and vomiting
  • Dark-colored urine
  • Skin rash
  • Fever 

Risk Factors

The following factors may increase your risk of developing toxic hepatitis:

  • Aging: Your liver breaks down harmful substances more slowly as you get older. Toxins and their byproducts will therefore persist in your body for longer.
  • Female sex: Women's livers are exposed to higher blood concentrations of harmful substances for longer periods because they appear to process certain toxins more slowly than men. 
  • Genetics: You may be more prone to toxic hepatitis if you inherit specific genetic mutations that alter the production and function of liver enzymes that break down toxins.
  • Medications: Using medication or an over-the-counter pain reliever that risks causing liver damage raises your risk of toxic hepatitis. This is especially true if you're taking multiple medications or taking more than the recommended dose.
  • Liver Diseases: If you have serious liver diseases like cirrhosis or nonalcoholic fatty liver disease, you are considerably more vulnerable to the effects of toxins.
  • Hepatitis Infections: Hepatitis B, C, or other hepatitis viruses that can stay in the body make your liver more vulnerable to toxic hepatitis.
  • Alcohol: The risk of toxicity increases when you drink alcohol while taking medications or herbal supplements. 
  • Industrial chemicals: Toxic hepatitis is a risk when working with some industrial chemicals.

Diagnosis

The following tests and procedures are used to diagnose toxic hepatitis:

Physical Exam: A physical exam and a medical history will most likely be taken by your doctor. Take all of your prescriptions, including over-the-counter medications and herbs, to your appointment. Let your doctor know if you work with industrial chemicals or have been exposed to pesticides, herbicides, or other environmental toxins.

Blood Tests: Blood tests such as liver function test (ALT,AST,Alkaline Phosphatase (ALP), Bilirubin, Total proetins, GGT etc) to check for high levels of certain liver enzymes and various components may be ordered by your doctor. The levels of these enzymes can indicate how well your liver is working.

Imaging: Your doctor may recommend imaging tests such as ultrasonography, computed tomography (CT scan), Magnetic resonance imaging (MRI) to obtain a clear picture of your liver. Magnetic Elastography and Transient Elastography are two other imaging procedures that may be used.

Liver Biopsy: A liver biopsy can help confirm toxic hepatitis and rule out other causes. A needle is used to extract a small sample of tissue you’re your liver during a liver biopsy. 

Treatment

Doctors will figure out what's causing the damage to your liver. Sometimes it's obvious what's causing your problems, and other times it takes a little more digging to find out. In most situations, eliminating exposure to the toxin causing liver inflammation can relieve the signs and symptoms you are experiencing.

The following are some of the treatments for toxic hepatitis:

Supportive: People with severe symptoms are more likely to get supportive therapy in the hospital, such as intravenous fluids and medication to alleviate nausea and vomiting. Your doctor will also monitor you for signs of liver damage.

Medication overdose reversal:  If an overdose of acetaminophen causes liver damage, you'll be given a chemical called acetylcysteine right away. The sooner this medication is given, the more chances to prevent liver damage. It works best if given within 16 hours of an acetaminophen overdose. Overdosing on toxic medicine requires immediate medical attention. People who overdose on drugs other than acetaminophen may benefit from treatments that remove or lessen the harmful effects of the offending drug.

Liver Transplant: A liver transplant may be the only option for some people if the liver is significantly damaged.  

Complications

Toxic hepatitis causes inflammation in the liver, which can cause scarring and damage. Cirrhosis, or liver scarring, makes it harder to function properly over time. Cirrhosis eventually leads to liver failure. Chronic liver failure can only be treated by a liver transplant.

Prevention

Toxic hepatitis cannot always be avoided because it is impossible to predict how you react to a given medicine. However, you can lower your chances of developing liver problems if you:

  • Limit the number of over-the-counter medications you take.
  • Only take medication as prescribed by your healthcare provider. 
  • Be cautious when using herbs and supplements.
  • Don't mix drugs with alcohol.
  • Take precautions when working with chemicals. 
  • Keep medicines and chemicals out of the reach of children.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 09, 2023.

References

https://ejmcm.com/article_5039_be2f0df5248a505bfd8a9c4492fac321.pdf

https://www.mayoclinic.org/diseases-conditions/toxic-hepatitis/symptoms-causes/syc-20352202#:~:text=Toxic%20hepatitis%20is%20an%20inflammation,of%20exposure%20to%20a%20toxin.

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