💊 Chapter 411: Drug- and Toxin-Induced Liver Injury

Nelson Textbook of Pediatrics 22nd Edition — Drug-induced liver injury (DILI) is a major cause of acute liver failure in children. Acetaminophen (predictable, N-acetylcysteine), valproate (microvesicular steatosis, contraindicated in POLG mutations), isoniazid, methotrexate (fibrosis), amiodarone, herbal supplements (kava, green tea extract, ma huang), and Amanita phalloides mushroom poisoning. Treatment: withdrawal of agent, N-acetylcysteine, supportive care, liver transplant for fulminant failure.

🌐 paeds.online — Pakistan's Pediatric Platform

📋 30 Clinical Scenarios — Drug- & Toxin-Induced Liver Injury

📇 High‑Yield Review Cards (Drug-Induced Liver Injury)

🩺 Clinical Presentations: Drug-Induced Liver Injury

Select a presentation for diagnostic clues and management.

📋 Stepwise Evaluation & Management of DILI

🔑 Key Principles — Drug- & Toxin-Induced Liver Injury (Nelson Ch.411)
• Acetaminophen: Dose-dependent centrilobular necrosis. Rx: N-acetylcysteine (NAC) IV or PO.
• Valproate: Microvesicular steatosis, hyperammonemia. Contraindicated in POLG mutations.
• Isoniazid (INH): Hepatocellular injury, can mimic viral hepatitis. Monitor LFTs.
• Methotrexate: Long-term use → fibrosis, cirrhosis. Risk increased with alcohol.
• Herbals: Kava (cholestatic), green tea extract (hepatocellular), ma huang (ephedra).
• Amanita phalloides: Amatoxin → delayed hepatotoxicity (8-24h), NAC + silibinin, transplant.

    ⚡ Reflex Prompts — DILI Clinical Decisions

    📖 Drug- & Toxin-Induced Liver Injury — Core Summary