What are the symptoms of drug-induced liver injury?

The incidence of drug-induced liver injury is relatively high, and sometimes it can even be life-threatening, so we must pay attention to timely detection of these diseases, such as common ones that can cause upper abdominal discomfort, nausea and vomiting, or severe patients may cause symptoms of liver failure.

1. Drug-induced liver disease can manifest as any type of acute or chronic liver disease known to date , among which acute liver damage accounts for more than 90% of the reported cases, and a small number of patients may develop life-threatening fulminant or severe liver failure.

2. If the acute drug-induced liver disease is of the hepatocellular type, it may manifest as the hepatitis type, with prodromal symptoms such as fatigue, decreased appetite, upper abdominal discomfort, nausea, vomiting, and dark urine 1 to 2 days before the onset of jaundice. Severe cases may present with liver failure, which may be complicated by hepatic coma and death. Biochemical examinations show significantly elevated ALT and AST, which may be accompanied by elevated serum bilirubin; it may also present as fatty liver type, with clinical features of fatty liver, azotemia and pancreatitis. Generally, after continuous use of the drug for more than 3 to 5 days, nausea, vomiting, anorexia, upper abdominal pain, dark urine, hepatomegaly, jaundice, decreased renal function, oliguria, increased blood urea nitrogen and metabolic acidosis may occur. Biochemical examinations showed significantly elevated ALT and AST, and serum bilirubin was generally lower than 17.1 μmol/L, but could be as high as 51.3 μmol/L. The prothrombin time is prolonged and hypoglycemia occurs occasionally. The prognosis of this disease is poor. If the drug is not stopped in time, the mortality rate is very high.

3. Acute drug-induced liver disease can also manifest as intrahepatic cholestatic drug-induced hepatitis , including simple cholestatic type. The clinical manifestations are insidious onset, often without prodromal symptoms, and no fever, skin pain or eosinophilia at the onset of the disease. The jaundice was mild and disappeared quickly after stopping the medication. Biochemical examinations show elevated AST, while alkaline phosphatase and cholesterol are mostly normal. Cholestatic hepatitis with inflammatory disease may present with fever, chills, nausea, abdominal distension, fatigue, rash, followed by jaundice, itchy skin, light-colored stools, enlarged and tender liver, and increased eosinophils. Biochemical examination showed that bilirubin, ALT, AST, cholesterol and alkaline phosphatase were all moderately to highly elevated. Mixed drug-induced hepatitis has both hepatitis-type and cholestatic manifestations.

4. Depending on the clinical type, chronic drug-induced liver disease may present with symptoms such as chronic active hepatitis or fatty liver disease, cholestatic liver disease, etc. If it is a vascular disease [including hepatic vein thrombosis, veno-occlusive disease (VOD)], non-cirrhotic portal hypertension (idiopathic portal hypertension), the main clinical manifestation is portal hypertension. VOD patients may develop liver failure, such as ascites, liver enlargement, abdominal distension and jaundice, which is manifested by a rapid increase in serum bilirubin and a significant increase in weight, indicating that VOD is serious and has a mortality rate of nearly 100%.