Etiology, Pathophysiology, Evaluation, and Management of Drug Induced Hepatotoxicity
DOI:
https://doi.org/10.53089/medula.v13i3.636Abstract
Drug induced liver injury (DILI) is an acute or chronic liver injury caused by drugs or herbal compounds that have been known for more than 1000 drugs and herbal compounds to cause hepatotoxicity classified based on the clinical picture of the mechanism of hepatotoxicity, or the histological picture of the liver biopsy. The annual incidence of DILI in the general population is below 15-20 per 100,000 population. DILI has 2 pathogenesis mechanisms, namely intrinsic, which is dose dependent, and idiosyncratic, which is more unpredictable. DILI is thought to be related to a combination of hospitalization, medications, and environmental factors. Host factors are patient age, sex, genetic polymorphism, immune status, and metabolism. Drug factors include dose, duration, weight, and level of lipophilicity. Environmental factors consist of alcohol use, diet, tobacco, and poisons. Abnormal patterns of liver tests can differentiate between types of liver injury. In hepatocellular injury, there is a marked increase in transaminases (usually 3 times the upper limit) compared to ALP levels. In cholestatic or cholestatic injuries, ALP is usually 3 times the upper limit of normal compared with transaminases. There is also a mixed injury pattern in which both aminotransferases and ALP are 3 times the upper limit of normal.
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