Toxic Hepatitis: Information on Causes, Diagnosis & Treatments

Toxic Hepatitis Overview

Chemical Exposure Liver Problems Toxic hepatitis is the body’s response from repeated chemical exposure that causes the liver to become inflamed. Humans consume and inhale many chemicals, often without intention including medications, pollutants, and industrial solvents. With repeated exposure, nearly any type of drug can cause toxic hepatitis that can eventually lead to chronic liver disease or cirrhosis of the liver.

The liver is most vulnerable to chemical exposure because it plays a fundamental role in metabolizing substances including chemicals in the body. The liver processes the drugs and chemicals that have entered the bloodstream to be removed by the organ and excreted from the kidneys. The process turns the chemicals into substances that are easily eliminated through urine or bile. However, while doing so, unstable toxins are often produced that cause injury or attack the liver.

Even minimal alcohol consumption can produce toxic levels especially when the individual uses other drugs or medications including acetaminophen. This is why doctors highly recommend avoiding drinking alcohol at all costs when taking certain medications.

Who Is at Risk for Toxic Hepatitis?

There are specific risk factors for developing toxic hepatitis. Some of these include:

  • Prescription Drugs and Over-The-Counter Pain Relievers – Liver damage can occur when taking over-the-counter pain relievers and certain medications and when taking most drugs at a higher dose than prescribed.

  • Liver Disease – Individuals suffering from serious liver disorders including nonalcoholic fatty liver disease and cirrhosis of the liver have an increased susceptibility to developing toxic hepatitis.

  • Hepatitis Sufferers – Individuals with a chronic infection of hepatitis A, B, or C leaves the liver exposed to developing toxic hepatitis.

  • Age – As a part of the aging process, it often takes much longer for the body to break down substances that are dangerous in the body. This means that the toxic substances and the byproducts they produce will remain in the body much longer than in younger years.

  • Consuming Alcohol – Drinking any amount of alcohol when taking herbal supplements or medications can increase the potential risk of developing toxicity in the bloodstream.

  • Gender – Women tend to metabolize specific toxins at a slower rate compared to men. This exposes their liver to higher concentrations of dangerous substances for an extended time and increases the potential risk of developing toxic hepatitis.

  • Genetic Mutations – Some individuals acquired toxic hepatitis because they have developed or inherited a specific gene mutation that affects enzymes in the liver that reduce the organ’s ability to break down toxins to be expelled from the body.

  • Workplace Exposure – Working in and around an environment filled with specific industrial chemicals can significantly increase the individual’s chance of developing toxic hepatitis.

Complications

If the liver becomes too inflamed, it can cause significant scarring and damage. The scarring over time will develop into cirrhosis of the liver, making it difficult for the organ to function properly. Eventually, the scar tissue will lead to organ failure requiring a liver transplant from a healthy donor.

Common Symptoms

Many of the common symptoms associated with toxic hepatitis are only identified through routine examinations involving a blood test. However, noticeable symptoms may include:

  • Fatigue

  • Loss of appetite

  • Unexpected weight loss

  • Jaundice where the skin and the whites of the eyes become yellow

  • Tea-colored or dark urine

  • Abdominal pain at the site of the liver (upper right side of the abdomen)

In extreme cases, the symptoms will involve severe upper abdominal pain or coma. Additionally, overdosing on some drugs including Tylenol (acetaminophen) and others can cause liver failure. An overdose of acetaminophen is often fatal and must be successfully treated immediately after it has been ingested.

Preventing Toxic Hepatitis

Prevention of hepatitis caused by exposure to toxic chemicals is challenging because the disease can occur unexpectedly whenthe body is exposed to certain medications and chemicals considered to be harmless. However, there are steps the patient can take to minimize the development of toxic hepatitis during daily activities and in a work environment. These preventative steps include:

  • Take prescription medications only as directed by the doctor and never overuse the drug.

  • use extreme caution when taking supplements and herbs.

  • Never mix medications with alcohol.

  • take extreme caution to avoid to chemicals whenever in a work environment.

Diagnosing Toxic Hepatitis

There is no one single test to accurately diagnosed toxic hepatitis. However, the doctor will perform a comprehensive physical examination and take a complete medical/personal history. The doctor will want to know any herbs or over-the-counter medications that have been taken and if there has been exposure to industrial chemicals including environmental toxins, herbicides, or pesticides.

Common test the doctor will perform an accurate diagnosis of toxic hepatitis include:

  • Blood Tests – The physician will likely perform a variety of blood tests to determine the presence of liver enzymes.

  • Imaging Tests – The physician may recommend an MRI (magnetic resonance imaging) scan, CT (computerized tomography) scan, and/or an ultrasound to capture visual imaging of the liver in great detail.

  • Liver Biopsy – Usually, verifying an accurate diagnosis of toxic hepatitis requires a liver biopsy, where the doctor uses a long needle to extract tissue samples from the liver to be analyzed under a microscope in a laboratory setting. However, transient elastography and magnetic elastography are providing noninvasive alternatives to gather information on the health of the liver.

Toxic Hepatitis Treatments

Once toxic hepatitis has been accurately diagnosed, the doctor will determine the extent and progression of the disease and the damage it has caused to the liver to ensure the patient receives the best treatment. Treatment often requires understanding what the exact cause to eliminate the potential of ongoing exposure to toxic chemicals that could lead to further liver inflammation.

Common options for treating toxic hepatitis could include:

  • Eliminate Toxic Exposure – The doctor may recommend that the patient eliminates any exposure to highly toxic substances that could occur in a workspace, from alcohol abuse, or the environment. If work-related, changing the place of work or the type of job in the work environment could stop exposure to toxins.

  • Supportive Care – The doctor will recommend steps to prevent malnourishment and dehydration and ensure that the patient receives adequate bed rest and consume a proper prescribed diet.

  • Discontinue Over the Counter Drugs – If it is determined that the toxic exposure came from over-the-counter medications, the patient should stop taking their NSAIDs (nonsteroidal anti-inflammatory drugs like Motrin and Aleve), acetaminophen (Tylenol), and others.

  • Antidotes – If the doctor determines that the liver damage is the result of over using acetaminophen, they typically recommend immediate doses of acetylcysteine as an antidote to prevent further damage to the liver.

  • Liver Transplant – If toxic hepatitis has progressed to the stage where liver failure is eminent and all other treatments have failed, the doctor will usually recommend the patient undergo a liver transplant to receive an organ from a healthy donor.

Liver transplants are not always an option for every patient, especially those who suffer from end stage cirrhosis caused by over consumption of alcohol. To be considered as a candidate for liver transplantation, these patients must usually complete an abstinence program to prove they have not had alcohol for at least 6 months.

Sources:

http://www.mayoclinic.org/diseases-conditions/toxic-hepatitis/home/ovc-20251578

https://my.clevelandclinic.org/health/articles/liver-disease

https://www.cdc.gov/mmwr/preview/mmwrhtml/00017883.htm

https://www.cancer.org/cancer/cancer-causes/general-info/known-and-probable-human-carcinogens.html

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