Toxic Hepatitis

The liver processes everything we consume, including chemicals, medications, and alcohol. But in some cases, these substances may cause serious injury to the liver, resulting in inflammation of the liver, a condition called as toxic hepatitis. It is also called as liver toxicity or hepatotoxicity. It may develop within hours or few days after the exposure to the toxin or may take several months.

Usually, mild hepatitis does not produce any symptoms, but when present they include:

  • Jaundice (yellowing of skin and eyes)
  • Either brown or white-colored stools
  • Dark or tea-colored urine
  • Nausea and vomiting
  • Loss of appetite
  • Pain in the upper right quadrant of the abdomen
  • Itching

The most important function of the liver is to break down the nutrients, chemicals, and other foreign substances present in the blood. However, it becomes difficult for the liver to process certain chemicals which can, in turn, become toxic and damage the liver. This leads to the inflammation of the liver.

Substances, which are associated with toxic hepatitis, are:

  • Alcohol – consumption of alcohol on a regular basis for several years
  • Herbs and supplements – cascara, comfrey, kava, chaparral, and ephedra
  • OTC pain relievers – frequent administration of over-the-counter drugs such as acetaminophen, aspirin, ibuprofen, etc.
  • Prescription drugs – certain antibiotics such as statins, anti-epileptic drugs, etc. when taken regularly

These medications damage the liver when taken in higher than the recommended doses.

  • Industrial chemicals – excessive exposure to carbon tetrachloride, vinyl chloride, paraquat (a herbicide) and polychlorinated biphenyls

The below factors can make you more prone to toxic hepatitis:

  • Aging- Elder people are at higher risk when exposed to toxic substance
  • Being female
  • Having hepatitis and other liver diseases
  • Inheriting certain genetic mutations
  • Working with certain industrial chemicals
  • History of street drug or alcohol abuse

Hepatitis can lead to scarring and liver damage which can eventually lead to cirrhosis. Thus, the liver cannot function normally, and slowly liver failure can happen.

Diagnosis mainly involves taking a thorough medical, medication, and occupational history. You will be asked related questions while collecting the information. A physical exam helps the doctor to know if the size of the liver has enlarged or if there is any associated tenderness.

  • Blood tests may be conducted to assess the liver functioning. They include measuring the AST, ALT, and serum bilirubin levels. Ethanol levels are checked in the case of an alcoholic abuser.
  • Imaging studies are conducted to look at the state of the liver.
  • A liver biopsy helps to assess the liver tissue directly under a microscope.

Usually, the inflammation resolves with the elimination of the toxic substance. But prolonged exposure to the toxin can lead to liver damage or even liver failure in some cases.

Toxic hepatitis treatment involves:

  • Eliminating the exposure to toxic substance either by changing your job or taking necessary precautions is the first measure of treatment.
  • Supportive conservative care includes a proper diet and measures to avoid and treat dehydration, bed rest, and prevention of malnourishment.
  • If acetaminophen has caused the damage, then acetylcysteine is administered immediately as an antidote to prevent further damage to the liver.
  • A liver transplant may be indicated when all the other treatments have failed or if acute or chronic liver failure has occurred. It involves replacement of the damaged liver with a healthy liver.

It may not be possible always to prevent toxic hepatitis because it is difficult to predict how our body reacts to certain chemicals, medications, etc. But taking certain measures may help to cut down the risk factors

  • Take the medications only as directed by the physician and if you are taking OTC make sure you don’t overuse it.
  • You should take extreme care while taking herbs or supplements and make sure you discuss the use of such supplements with your doctor.
  • Never mix alcohol and drugs as they may be highly dangerous
  • Be alert and take special care of you are working in some chemical industry.