title: Hepatocellular injury with hyperaminotransferasemia after cresol ingestion.
abstract: A 42-year-old man attempted suicide by ingesting about 150 mL of a saponated cresol solution containing about 50% cresol. His serum aminotransferase concentrations were elevated, and a coagulopathy was present at the time of admission, 15 hours after ingestion. The hyperaminotransferasemia and coagulopathy worsened on the second day, but resolved thereafter with supportive therapy. Histologic examination of a biopsy specimen obtained on the 14th day demonstrated focal dropout of hepatocytes (which were replaced by reticulin and collagen fibers), ballooning or hydropic degeneration of hepatocytes, and rapid regeneration with small hepatocytes in the periportal zones as well as in the centrilobular zones. A rapid onset of illness with periportal hepatocellular injury is inconsistent with damage due to a hepatotoxic metabolite of p-cresol produced by cytochrome P450, which has been suggested by studies in vitro. A direct transient noxious effect mediated via the portal or arterial circulation may be involved in hepatic injury after cresol ingestion.
authors.affiliation: Department of Emergency and Critical Care Medicine, Kitasato University, School of Medicine, Sagamihara Kanagawa, Japan. yk119kitasato-u.ac.jp
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Kamijo
authors.forename: Kazui
authors.initials: K
authors.lastname: Soma
authors.forename: Mikio
authors.initials: M
authors.lastname: Kokuto
authors.forename: Makoto
authors.initials: M
authors.lastname: Ohbu
authors.forename: Chiaki
authors.initials: C
authors.lastname: Fuke
authors.forename: Takashi
authors.initials: T
authors.lastname: Ohwada
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000097:blood*; D002606:Charcoal / Q000627:therapeutic use; D003408:Cresols / Q000378:metabolism / Q000506:poisoning*; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism; D015738:Famotidine / Q000627:therapeutic use; D022781:Hepatocytes / Q000187:drug effects / Q000201:enzymology / Q000473:pathology; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000201:enzymology / Q000293:injuries*; D008115:Liver Regeneration / Q000187:drug effects / Q000502:physiology; D008297:Male; D013406:Suicide, Attempted
chemical_list: D000897:Anti-Ulcer Agents; D003408:Cresols; D002606:Charcoal; D015738:Famotidine; D003577:Cytochrome P-450 Enzyme System; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; C077977:cresol