Hepatitis, Toxin Induced, Acute
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: K71.6 DESCRIPTION Liver damage attributed to a toxin or medicine. The most common herbal toxin in South Africa is atractyloside ( Impila ), which causes a Reye’s-like syndrome, with liver failure. Senecio ingestion is also seen but this causes endothelial damage in hepatic veins, resulti
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: K71.6
DESCRIPTION
Liver damage attributed to a toxin or medicine. The most common herbal toxin in South Africa is atractyloside (Impila), which causes a Reye’s-like syndrome, with liver failure. Senecio ingestion is also seen but this causes endothelial damage in hepatic veins, resulting in hepatic sinudoidal obstruction syndrome with secondary cirrhosis and portal hypertension.
There are many medicines that are hepatotoxic. The commonest are:
- anticonvulsants,
- immunosuppressants,
- cytotoxics,
- anti-inflammatories,
- analgesics,
- antituberculous medication,
- antiretrovirals.
DIAGNOSTIC CRITERIA
- Depends on the toxin, but the history is usually diagnostic.
- Impila poisoning, given orally or rectally, may result in anicteric hepatic encephalopathy.
- Presents with onset of severe vomiting, followed by anuria and then rapid depression of level of consciousness, progressing to seizures and/or coma within a day.
GENERAL AND SUPPORTIVE MEASURES
- Stop all potentially hepatotoxic medication, including paracetamol.
- Education regarding herbal toxins, if appropriate.
MEDICINE TREATMENT
For paracetamol poisoning:
See: Paracetamol poisoning.
Acute liver failure/Hepatic encephalopathy:
See: Liver failure, acute.
REFERRAL
- All cases of hepatic encephalopathy due to toxin ingestion.
- All cases in which rechallenge of medication is considered.
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024
Chapter 2: Alimentary Tract, 2.3 Hepatic Disease, 2.3.7 Hepatitis, Toxin Induced, Acute