It is understood that liver disease patients are increasing year by year, in addition to hepatitis B and other viral hepatitis, alcoholic liver, the incidence of drug-related hepatitis has now ranked fourth in liver disease, the number of patients accounted for nearly 10% of the hospital’s outpatient volume. Currently, drug-induced liver disease accounts for 2-5% of hospitalized patients with jaundice, about 10% of hospitalized patients with so-called acute hepatitis, and up to 20% or more in elderly liver diseases.
What is drug liver?
Drug liver, also known as drug liver injury, is, as the name suggests, liver damage caused by drugs or metabolites of drugs. Due to the increasing number of new drugs and drug abuse, the incidence of drug-related liver disease is increasing year by year and has ranked fourth in liver disease.
We know that “drugs are toxic in three ways”, but can all drugs cause liver damage?
The liver is the “detoxification factory” for drug transformation and metabolism, and is an important organ for synthesis, metabolism, decomposition and detoxification in the human body. Some drugs have to be broken down by the liver before the active ingredients can be brought into play. As we all know, “medicine is three parts poisonous”, if you take medicine without professional guidance, can not do a reasonable dose, indications, treatment and with the drug into the human body, the first to suffer the toxic side effects of damage is bound to be the liver. Many patients believe that the more drugs they take, the better, so that they can feel safe. This inappropriate use of drugs is not only unsafe, but also aggravate the disease or serious adverse reactions, so it is not appropriate to use too much too mixed. However, there are a few drugs that are mainly metabolized through the kidneys and have relatively little effect on the liver.
Generally there are those common clinical drugs can cause drug liver it?
There are six types of drugs that are most likely to damage the liver and cause “drug liver” if not taken properly, including anti-tuberculosis drugs, lipid-lowering drugs, antibiotics, tumor chemotherapy drugs, antipyretic and analgesic drugs, sleeping pills and so on.
Usually, when we have a cold and fever and headache, we often go to the pharmacy to get some drugs to eat, are these drugs safe?
This kind of medicine in the major market pharmacy has a large number of sales, such as many people are familiar with the Crypto, New Contec, Compeed, sense of health, white plus black, cold pass, Tylenol, Benadryl, Tektronix, Sensol, cold and fever punch and so on a series of products, these drugs almost all contain antipyretic and analgesic ingredients, the most is acetaminophen. Acetaminophen is the number one killer of drug-induced liver injury in the United States. When taken in excess or over a long period of time, it can cause liver damage. However, because most of these drugs are compounded, the acetaminophen content is relatively safe.
What are the symptoms that indicate a drug-related liver injury that requires prompt medical attention?
It is important to note that people should not just go out and buy their own medications, as each person’s specific condition and cause are different, and they should go to the hospital to receive regular treatment and take the medication as prescribed, without increasing the dose, extending the course of treatment or using the medication irregularly. During the medication period, the liver function should be checked regularly, and any changes in the original disease should be carefully observed, whether there are symptoms such as fatigue, nausea, vomiting, anorexia, hepatomegaly, liver pain, jaundice, rash, fever, chills, elevated bilirubin and transaminases. If liver damage has occurred as a result of drug use, the suspected drug should be discontinued immediately and a doctor should be consulted as soon as possible to determine the cause by giving a history of recent drug use.
Who is prone to drug-related liver disease?
There are two factors that contribute to the development of drug-related liver disease: the individual and the drug. The most relevant individual factor is our genetic background, which is known as “genetic polymorphism” in medicine. How do you understand “genetic polymorphism”? There are black, white and yellow people in the world. This is determined by our genes that determine the color of our skin. So each person is more sensitive to that kind of drug, and is prone to drug liver and their own genes have a lot to do with it. In addition, the age, gender, nutritional status, and the individual have a certain relationship.
The main drug factors are drug dose, duration of application, and drug interactions. Generally speaking, the higher the dose, the more serious the liver damage. Some drugs cause liver damage related to the duration of drug use, for example, isoniazid causes liver damage more than 3 months after drug use.
I clearly remember that 2 weeks before the Spring Festival in 2009, I received a phone call that a little girl had liver disease. I asked the family and her local hospital doctor in detail and decided to transfer her to our department after understanding her specific condition. This little girl had caught a cold after gym class and took 2 tablets of cold and fever medicine (Anacin) on her own, which did not work well, and then started intravenous cephalosporin antibiotics. During the course of the medication, her body temperature was controlled, but 5 days later she developed a severe decrease in appetite, abdominal distension, yellow urine and yellow skin. The liver damage was found to be severe and various viral liver diseases such as hepatitis B and C were ruled out. The disease progressed very quickly 10 days later and symptoms of hepatic encephalopathy such as irritability and babbling appeared. Then the little girl before the onset of the drug in fact only Anacin and cephalosporin antibiotics, is the regular use of cold, I believe that many viewers friends also after the cold also took such a prescription. However, this little girl had acute liver failure due to these two drugs, which was life-threatening. This is the “genetic polymorphism” that determines her sensitivity to this type of drug.
What are the common features of drug-related liver injury in terms of age, gender and nutritional status?
1, age.
Generally, the elderly are prone to drug hepatotoxicity, mainly because the activity of the microsomal enzyme system in the liver cells is reduced, the ability to metabolize certain drugs is reduced. The elderly often use a variety of drugs together, drugs interfere with each other. Some drugs are mainly excreted by the kidneys, and the glomerular filtration of the elderly is often reduced, reducing renal excretion, which may cause an increase in the blood concentration of drugs, in addition to compensatory bile excretion. In addition, there are many unknown factors that can make the elderly more prone to drug hepatotoxicity.
2. Gender.
Drug-related liver damage caused by idiosyncratic metabolic reactions is mostly seen in women.
3, nutritional status.
Nutritional deficiency, especially protein deficiency, can reduce the molecules with protective effects in the liver, such as glutathione, increasing the susceptibility of the body to drug hepatotoxicity.
4. Pre-existing diseases of the liver.
For example, the metabolism of many drugs is reduced in patients with hepatic sclerosis, so that the drugs are prone to accumulate in the liver and cause liver damage. Liver disease patients with severe impairment of liver function are often particularly sensitive to general doses of sedative drugs (such as morphine drugs), and can even induce hepatic encephalopathy.
What are the clinical manifestations of drug liver?
The manifestations of drug-related liver injury can range from no clinical symptoms to severe uncomfortable clinical symptoms such as rash, fever, malaise, decreased appetite, nausea, vomiting, abdominal distention, yellowing of the skin and mucous membranes, and yellowing of the urine. Simply put, some patients do not have clinical symptoms and seek medical attention for elevated transaminases found on physical examination, while some patients can also present with acute hepatitis, chronic hepatitis, liver failure, intrahepatic cholestasis, fatty liver, etc.
What is the treatment for drug-induced liver disease?
The main treatment for drug liver is to stop using drugs that have the potential to cause drug-related liver injury and to avoid using multiple drugs at the same time as much as possible. Clinically, for acetaminophen poisoning, N-acetylcysteine has special efficacy. In severe cases of Gansu mortgage, toxic intrahepatic cholestasis and chronic liver injury progressing to cirrhosis, artificial liver support or liver transplantation may be considered.
How to prevent drug-related liver injury?
For drug allergies or allergic history, poor liver and kidney function, newborns and people with nutritional disorders when using drugs must go to a regular hospital, tell your doctor your past medical history. Once liver function abnormalities or obvious clinical symptoms appear, discontinue the drug and seek medical attention. Finally, avoid reuse of drugs with liver damage.