title: Kava hepatotoxicity: comparison of aqueous, ethanolic, acetonic kava extracts and kava-herbs mixtures.
abstract: BACKGROUND
  Ethanolic and acetonic kava extracts have previously been causally related to rare hepatotoxicity observed in patients from Germany and Switzerland, but causality assessment was not performed in cases of patients having taken the traditional aqueous kava extracts of South Pacific islands or kava-herbs mixtures.
  
  
  OBJECTIVE
  To study the possible hepatotoxicity of aqueous kava extracts of the South Pacific Islands.
  
  
  METHODS
  Causality of hepatotoxicity by aqueous kava extracts and kava-herbs mixtures was assessed, using the updated score of the quantitative CIOMS (Council for the International Organizations of Medical Sciences).
  
  
  RESULTS
  Causality was established in five patients from New Caledonia, Australia, the United States and Germany for aqueous kava extracts and kava-herbs mixtures. A comparison with 9 patients from Germany and Switzerland with established causality of hepatotoxicity by ethanolic and acetonic kava extracts reveals that the clinical picture in all 14 patients is similar, independently whether aqueous, ethanolic and acetonic kava extracts or kava-herbs mixtures were used.
  
  
  CONCLUSIONS
  Kava hepatotoxicity occurs also with traditional aqueous kava extracts of the South Pacific islands and thereby independently from ethanol or acetone as chemical solvents, suggesting that the toxicity is linked to the kava plant itself with a possibly low quality of the used kava cultivar or kava plant part rather than to chemical solvents.
authors.affiliation: Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Johann Wolfgang Goethe-University of Frankfurt/Main, Leimenstrasse 20, D-63450 Hanau, Germany. rolf-teschke@klinikum-hanau.de
authors.forename: Rolf
authors.initials: R
authors.lastname: Teschke
authors.forename: Alexander
authors.initials: A
authors.lastname: Genthner
authors.forename: Albrecht
authors.initials: A
authors.lastname: Wolff
mesh_terms: D000293:Adolescent; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D020901:Kava / Q000009:adverse effects* / Q000737:chemistry; D008099:Liver / Q000473:pathology*; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D010139:Pacific Islands; D010936:Plant Extracts / Q000009:adverse effects*; D010946:Plants, Medicinal / Q000009:adverse effects; D012997:Solvents; D014481:United States
chemical_list: D010936:Plant Extracts; D012997:Solvents