Liver damage caused by drugs and toxins

1. Big picture

Drug- and toxin-induced liver injury means liver damage caused by prescription drugs, over-the-counter drugs, herbal products, supplements, recreational drugs, industrial toxins, or natural toxins such as poisonous mushrooms.

For the exam, think in 3 steps:

1. Recognize the liver injury pattern: hepatocellular, cholestatic, mixed, fatty liver, vascular injury, chronic fibrosis/cirrhosis.
2. Identify the dangerous cause: especially paracetamol/acetaminophen overdose, Amanita phalloides mushroom poisoning, antituberculosis drugs, antiepileptics, herbal/bodybuilding supplements.
3. Treat immediately: stop the drug, stabilize acute liver failure, give the correct antidote if available, and refer early for liver transplantation if severe.

The most important exam trap: drug-induced liver injury is not always dose-dependent. It can be predictable and dose-related, or unpredictable/idiosyncratic.

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