title: Drug-Induced Liver Injury.
abstract: Drug-induced liver injury (DILI) can result from both idiosyncratic and intrinsic mechanisms. This article discusses the clinical impact of DILI from a broad range of medications as well as herbal and dietary supplements. Risk factors for idiosyncratic DILI (IDILI) are the result of multiple host, environmental, and compound factors. Some triggers of IDILI often seen in critical care include antibiotics, antiepileptic medications, statins, novel anticoagulants, proton pump inhibitors, inhaled anesthetics, nonsteroidal anti-inflammatory agents, methotrexate, sulfasalazine, and azathioprine. The mechanism of IDILI due to these medications varies, and the resulting damage can be cholestatic, hepatocellular, or mixed. The primary treatment of IDILI is to discontinue the causative agent. DILI due to acetaminophen is intrinsic because the liver damage is predictably aligned with the dose ingested. Acute acetaminophen ingestion can be treated with activated charcoal or N-acetylcysteine. Future areas of research include identification of mitochondrial stress biomarkers and of the patients at highest risk for DILI.
authors.affiliation: Leslie Hamilton is Associate Professor of Clinical Pharmacy, University of Tennessee Health Science Center College of Pharmacy, Knoxville, Tennessee. Angela Collins-Yoder is Clinical Professor, Capstone College of Nursing, and Critical Care Nurse Specialist, Sacred Heart Pensacola Hospital, 8370 Foxtail Loop, Pensacola, FL 32526 (acollins-yoder@ua.edu). Rachel E. Collins is a PharmD candidate, Auburn University Harrison School of Pharmacy, Auburn, Alabama.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Hamilton
authors.affiliation: Leslie Hamilton is Associate Professor of Clinical Pharmacy, University of Tennessee Health Science Center College of Pharmacy, Knoxville, Tennessee. Angela Collins-Yoder is Clinical Professor, Capstone College of Nursing, and Critical Care Nurse Specialist, Sacred Heart Pensacola Hospital, 8370 Foxtail Loop, Pensacola, FL 32526 (acollins-yoder@ua.edu). Rachel E. Collins is a PharmD candidate, Auburn University Harrison School of Pharmacy, Auburn, Alabama.
authors.forename: Angela
authors.initials: A
authors.lastname: Collins-Yoder
authors.affiliation: Leslie Hamilton is Associate Professor of Clinical Pharmacy, University of Tennessee Health Science Center College of Pharmacy, Knoxville, Tennessee. Angela Collins-Yoder is Clinical Professor, Capstone College of Nursing, and Critical Care Nurse Specialist, Sacred Heart Pensacola Hospital, 8370 Foxtail Loop, Pensacola, FL 32526 (acollins-yoder@ua.edu). Rachel E. Collins is a PharmD candidate, Auburn University Harrison School of Pharmacy, Auburn, Alabama.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Collins
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology / Q000451:nursing; D003422:Critical Care / Q000592:standards*; D019587:Dietary Supplements / Q000009:adverse effects; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis* / Q000188:drug therapy* / Q000451:nursing; D004502:Education, Medical, Continuing; D006801:Humans; D010936:Plant Extracts / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D010936:Plant Extracts
keywords: adverse drug reactions; clinical practice guidelines; drug-induced liver injury; herbal and dietary supplements