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Toxic hepatitis is the inflammation of the liver that occurs as a reaction to certain substances you are exposed to. These substances can include alcohol, chemicals, drugs, or nutritional supplements. The liver performs several vital functions, such as converting proteins and sugars into usable energy and byproducts for biological processes. Additionally, it acts as a filter, removing chemicals and drugs from the bloodstream, while also storing and releasing vitamins, hormones, and minerals as needed. The liver produces bile, a greenish fluid stored in the gallbladder, which aids in the breakdown of fats in the small intestine.
Toxic hepatitis can develop rapidly, within hours or days of toxin exposure, or it may take months of regular exposure before symptoms become apparent. If exposure to the toxin ceases, the symptoms of toxic hepatitis often subside. However, it’s important to note that toxic hepatitis can cause permanent damage to the liver, leading to irreversible scarring of liver tissue (cirrhosis), and in severe cases, liver failure, which can be life-threatening.
Symptoms
Toxic hepatitis, in its milder forms, may not exhibit any noticeable symptoms and might only be detected through blood tests. However, when symptoms do arise, they can include:
- Nausea
- Vomiting
- Loss of appetite
- Fever
- Jaundice (yellowing of the skin and eyes)
- Pain or swelling in the upper right abdomen
- Fatigue
- Dark-colored urine
- Fluid accumulation in the abdomen (ascites)
- Itching
The onset of symptoms can vary and may take days, weeks, or even months after exposure to the toxic chemicals or drugs. These symptoms can resemble those of other liver disorders. In chronic cases of toxic hepatitis, which occur over a long period, the liver may sustain extensive damage, leading to irreversible scarring called cirrhosis. Severe liver failure, which can be life-threatening, may also develop.
If you experience any worrisome signs or symptoms, it is important to seek medical attention promptly. Overdosing on certain medications, such as acetaminophen (Tylenol, others), can result in liver failure. If you suspect an adult or child has taken an overdose of acetaminophen, immediate medical care is necessary. Possible signs and symptoms of an acetaminophen overdose include:
- Loss of appetite
- Nausea and vomiting
- Upper abdominal pain
- Coma
Causes
Toxic hepatitis is the result of liver inflammation caused by exposure to harmful substances. It can also occur when excessive amounts of prescription or over-the-counter medications are taken. The liver’s function is to eliminate and metabolize drugs and chemicals from the bloodstream, but the process of breaking down toxins produces byproducts that can harm the liver. While the liver has the ability to regenerate, prolonged exposure to toxic substances can lead to severe and potentially irreversible damage.
The common causes of toxic hepatitis include:
- Alcohol: Alcohol abuse or dependency can harm the liver, especially when mixed with other substances. The liver may become inflamed and can progress to liver failure.
- Nonprescription painkillers: Regularly taking certain medications such as aspirin, ibuprofen, naproxen, and acetaminophen, particularly with alcohol, may harm the liver.
- Prescription medications: Amoxicillin-clavulanate, azathioprine, niacin, ketoconazole, certain antivirals and anabolic steroids are all associated with substantial liver impairment. Other drugs may be hazardous to some patients, particularly the elderly or those with viral hepatitis.
- Supplements and herbs: Liver damage can possibly occur in children who consume excessive amounts of vitamin supplements. Aloe vera, black cohosh, cascara, chaparral, comfrey, kava, ephedra, among others are some herbs that are toxic to the liver. (1)
- Industry-grade chemicals: Herbicide paraquat, dry cleaning solvent carbon tetrachloride, vinyl chloride, and polychlorinated biphenyls are substances that can induce liver damage. Frequent exposure to these job-related chemicals can harm the liver.
Risk factors
There are various risk factors that can increase an individual’s susceptibility to developing toxic hepatitis. These factors include:
- Age: As you grow older, the metabolic process of your liver, responsible for breaking down harmful substances, tends to slow down. Consequently, toxins and their byproducts linger in your body for an extended period.
- Gender: Women are more susceptible to toxic hepatitis than men due to the relatively slower metabolism of certain toxins. Higher blood levels of harmful substances can remain in their livers for an extended period.
- Using non-prescription painkillers or specific prescribed medications: Consuming multiple medications or exceeding the recommended dosage of a medication, such as non-prescription painkillers, can potentially harm the liver and raise the likelihood of developing toxic hepatitis.
- Liver disorder: A person is more vulnerable to the impacts of toxins when he or she is suffering from a severe liver condition like cirrhosis or nonalcoholic fatty liver disease.
- Infected with hepatitis: Hepatitis B, hepatitis C, or one of the exceptionally uncommon hepatitis viruses can survive in the body. Persistent infection with any of these hepatitis viruses renders the liver more susceptible to damage.
- Alcohol abuse: The risk for toxic hepatitis increases when consuming alcohol alongside medications or specific herbal supplements.
- Genetic mutations: The presence of specific genetic mutations can increase one’s vulnerability to toxic hepatitis. Inheriting these mutations impacts the production and functionality of liver enzymes responsible for metabolizing toxins.
- Exposure to industrial toxins: Susceptibility to toxic hepatitis increases with regular or occupational exposure to certain industrial chemicals.
Diagnosis
The process of diagnosing toxic hepatitis typically involves a thorough inquiry into one’s medical history and conducting a physical examination. The doctor will inquire about the usage of prescribed medications, over-the-counter drugs, vitamins, and herbal supplements, as well as the frequency of alcohol consumption. It is advisable to bring the original packaging of all medications when visiting the doctor to aid in the consultation.
During the physical examination, the physician will assess the abdomen for any signs of tenderness, swelling, or pain. It is important to inform the doctor about any occupational exposure to toxins as it can aid in the diagnosis. To confirm the condition, several tests may be necessary, including:
- Imaging tests: A doctor may recommend an imaging test to generate an image of the liver using ultrasound, computerized tomography (CT), or magnetic resonance imaging (MRI). Additional imaging tests that could be suggested including magnetic elastography and transient elastography.
- Blood tests: These aims to check for elevated levels of specific liver enzymes and bilirubin in the blood. Bilirubin is a byproduct of the breakdown of old blood cells. The enzyme levels can indicate how well the liver is working. If blood levels of liver enzymes and bilirubin are higher than normal, it can indicate liver damage.
- Overdose tests: To screen for excessive levels of drugs or alcohol, blood and urine tests may be performed.
- Liver biopsy: A liver biopsy is a procedure that aids in confirming the diagnosis of toxic hepatitis and ruling out other potential causes. It involves using a needle to extract a small tissue sample from the liver, which is then examined under a microscope.
Treatment
The treatment approach for toxic hepatitis is contingent upon the underlying cause of the condition. Typically, discontinuing exposure to the harmful substance responsible for liver inflammation is the primary step in alleviating symptoms. While the liver possesses the ability to regenerate and replace damaged liver cells, noticeable improvement may require several weeks or months to manifest.
There are several treatments available for toxic hepatitis, such as:
- Supportive care: The healthcare provider will closely monitor for any indications of liver damage. To relieve severe symptoms such as vomiting and nausea, supportive care in a hospital setting may be necessary. Drugs and intravenous fluids may be administered.
- Medications for acetaminophen-induced liver damage: Administering acetylcysteine promptly after an acetaminophen overdose is crucial for mitigating liver damage. The effectiveness of this medication in limiting harm is significantly enhanced when given within 16 hours of the overdose.
- Emergency medical attention: Emergency care is crucial for individuals who experience an overdose of a toxic medication. In cases where the overdose involves medications other than acetaminophen, specific treatments may be beneficial in eliminating the harmful substance from the body or mitigating its toxic effects.
- Liver transplantation: Cases where liver function is severely compromised, a liver transplant may be the only available option. This surgical procedure involves the removal of the diseased liver and its replacement with a healthy liver from either a deceased or living donor. While most liver transplants utilize organs from deceased donors, there are instances where a living donor can donate a portion of their liver for transplantation.
