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Drug-Induced Liver Injury

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Adverse drug reactions in children are uncommon. Nevertheless, drug-induced hepatotoxicity, when it occurs, must be promptly recognized, and the offending agent discontinued, although cessation does not always result in rapid recovery. Delays in recognizing hepatic injury may significantly contribute to morbidity, resulting in a need for liver transplantation or in death.1-5

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The role of the liver in the processing or biotransformation of xenobiotics (foreign substances) is discussed in Chapter 418. Mechanisms of hepatoxicity vary, as they depend on the drug, dosage, and patient factors such as age, gender, nutrition, and genetic predisposition. In general, medicinal and environmental agents known to cause hepatotoxicity have been characterized as predictable (intrinsic) or unpredictable (idiosyncratic) hepatotoxins. The patterns of liver injuries are clinically and histopathologically diverse (Table 422-1).

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Table 422-1. Clinical and Pathologic Findings in Drug-Induced Liver Disease in Children

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