Toxin-Induced Hepatic Injury

Toxins such as pharmaceuticals, herbals, foods, and supplements may lead to hepatic damage. This damage may present as nonspecific symptoms in the setting of liver test abnormalities. Most cases involving toxin-induced damage are caused by acetaminophen. The most important step in the patient evaluation is to gather an extensive history that includes toxin exposure and excludes common causes of liver dysfunction. Patients whose hepatic dysfunction progresses to acute liver failure may benefit from transfer to a transplant service for further management. Currently, the mainstay in management for most exposures is stopping the offending agent. This manuscript will review the incidence, pathophysiology, diagnosis and management of the different forms of toxin-induced hepatic injury and exam in-depth the most common hepatic toxins.