title: Acute amiodarone liver toxicity likely due to ischemic hepatitis.
abstract: BACKGROUND
  Hepatotoxicity due to intravenous amiodarone (HIVAD) is a rare side effect with a distinct pattern of enzyme disturbances compared to liver damage from oral amiodarone. Intravenous amiodarone is administered for acute arrhythmias often causing heart failure. The enzyme abnormalities and clinical setting are very similar to that of ischemic hepatitis, a far more common condition.
  
  
  OBJECTIVE
  To ascertain if acute HIVAD exists as a separate entity or whether reported cases may be explained by ischemic hepatitis
  
  
  METHODS
  In this case-control retrospective study the files of hospitalized patients with markedly elevated aminotransferases were reviewed for the diagnoses of HIVAD or ischemic hepatitis. Medline was searched for published cases of HIVAD. Pooled data of all patients with HIVAD were compared to a control group with ischemic hepatitis.
  
  
  RESULTS
  There were no significant differences in the clinical characteristics, laboratory results or histological findings between HIVAD and ischemic hepatitis patients.
  
  
  CONCLUSIONS
  In our opinion, there is currently insufficient data to support the existence of distinct HIVAD, and ischemic hepatitis is a more probable diagnosis in most reported cases. Withdrawing amiodarone because of assumed hepatic damage could deprive patients of a life-saving therapy.
authors.affiliation: Department of Gastroenterology, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel. nathang@tasmc.health.gov.il
authors.forename: Nathan
authors.initials: N
authors.lastname: Gluck
authors.forename: Mordechai
authors.initials: M
authors.lastname: Fried
authors.forename: Reuven
authors.initials: R
authors.lastname: Porat
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006505:Hepatitis / Q000097:blood / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000150:complications / Q000503:physiopathology; D007262:Infusions, Intravenous; D007511:Ischemia / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D008099:Liver / Q000098:blood supply* / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone