Drug-induced acute liver failure.
Acute liver failure is the most severe expression and represents the first cause of fatalities related to drugs. As a consequence, it is also the first cause of drug withdrawal from the pharmaceutical market. The incidence of drug-induced hepatotoxicity in the general population has been recently estimated to be around 14/100,000 inhabitants in a Western country. Drugs appear to be responsible for 10-52% of all causes of acute liver failure. In Western countries, paracetamol (acetaminophen) represents the first cause of all liver failures. The contribution of non-paracetamol drugs given at normal doses is equivalent to that of combined viral hepatitis A and B. The natural prognosis varies between drugs. The spontaneous mortality rate ranges from 32% to 50% for paracetamol intoxication and more than 75% for other drugs. The preventive occurrence of drug hepatotoxicity and the course to acute liver failure is rather limited. It is recommended to stop the administration of a suspected drug when alanine aminotransferase levels increase to more than 3-5 times the upper limit of normal. In paracetamol intoxication, the rapid administration of N-acetylcysteine is a classical antidote. At the stage of liver failure, treatment is mostly supportive. Since irreversible damage is unpredictable, early transfer to a transplantation centre should be considered.
Larrey
Dominique
D
Department of Gastroenterology, Hepatology and Liver Transplantation, Hôpital Saint Eloi, Montpellier School of Medicine and INSERM Unit 632, Montpellier, France. d-larrey@chu-montpellier.fr
Pageaux
Georges-Philippe
GP
D000082:Acetaminophen / Q000506:poisoning; D018712:Analgesics, Non-Narcotic / Q000506:poisoning; D006801:Humans; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy; D011379:Prognosis; D012307:Risk Factors
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen