title: Drug-induced liver injury in children.
abstract: OBJECTIVE
  Drug-induced liver injury (DILI) is an underrecognized cause of pediatric liver disease, accounts for almost 20% of pediatric acute liver failure cases, and is a major reason for liver transplantation in the USA. This article reviews the pathogenesis of DILI, approach to diagnosis and management, and highlights recent pediatric DILI case series.
  
  
  RESULTS
  Select individuals have an increased propensity to develop DILI. Known genetic polymorphisms of enzymes and host factors play an important role in medication management and influence the clinical outcome in 20-25% of all drug therapies. Children are more likely to have mitochondrial dysfunction from drugs, increasing their susceptibility to severe liver injury or acute liver failure. Antibiotics and central nervous system agents account for the majority of pediatric DILI in the West, although herbals are becoming more common.
  
  
  CONCLUSIONS
  Clinical features of DILI vary and overlap so exclusion of other conditions, identification of latency period and risk factors, and use of a searchable database can aid evaluation. Treatment consists of cessation of the offending agent and supportive care. Areas needing further research include elucidating mechanisms, identifying at risk individuals, and therapeutic interventions.
authors.affiliation: aBaylor College of Medicine bPediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Houston, Texas, USA.
authors.forename: Mansi D
authors.initials: MD
authors.lastname: Amin
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Harpavat
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Leung
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology* / Q000517:prevention & control / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004791:Enzyme Inhibitors / Q000009:adverse effects; D024841:Fluoroquinolones / Q000009:adverse effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004791:Enzyme Inhibitors; D024841:Fluoroquinolones; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors