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DRUG-INDUCED INJURY

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Adverse drug reactions in children are uncommon. Nevertheless, drug-induced hepatotoxicity must be promptly recognized and the offending agent discontinued. Delays in recognizing drug-induced hepatic injury may result in significant morbidity, including a need for liver transplantation or death. Comprehensive and updated online information on drug-induced liver injury caused by prescription and nonprescription drugs, herbals, and dietary supplements is available at http://www.livertox.nih.gov.

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The role of the liver in the processing or biotransformation of xenobiotics (foreign substances) is discussed in Chapter 413. Mechanisms of hepatotoxicity vary, depending on the offending drug, dose, and host factors such as age, sex, nutritional status, and genetic predisposition. In general, medicinal and environmental agents known to cause liver damage have been characterized as predictable (intrinsic) or unpredictable (idiosyncratic) hepatotoxins. The patterns of liver injuries are clinically and histopathologically diverse (Table 417-1).

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Table 417-1abClinical and Pathologic Findings in Drug-Induced Liver Disease in Children

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