The liver is one of the most important and largest organs in our body. It works like a big factory inside our body. The liver performs many important functions, such as filtering out toxins that enter the body, helping with digestion, and storing energy. But did you know that some of the medicines we take every day, the alcohol we drink, or some chemicals we unknowingly enter our body can damage this hard-working liver, that is, become 'poisoned'? Today we are talking about this serious condition called 'Toxic Hepatitis' in medicine, which is liver poisoning.
Simply put, what is Toxic Hepatitis?
Toxic Hepatitis, or liver poisoning, is when a toxin, a substance that is harmful to our body, damages the liver cells and causes the liver to swell. In medicine, we call this swelling ``inflammation.`` This toxic substance can enter our body in several ways.
- By swallowing: By taking too much of some of the medications we take, by drinking alcohol, or by swallowing another chemical.
- By inhalation: By breathing in toxic chemicals that are mixed into the air in some factories, garages, or paint shops.
- By absorption through the skin: Strong chemicals, such as some pesticides, can enter the body through skin contact.
This is how our liver is damaged as it tries to filter out the toxins that enter the body. When this damage occurs over time, the liver may even become permanently dysfunctional.
Are there main types of Toxic Hepatitis?
Yes, this condition can be divided into two main types depending on how it occurs.
- Acute Toxic Hepatitis: This is a condition that occurs suddenly. Symptoms begin to appear within a few hours or days after the toxic substance is ingested. For example, this condition can occur if you take too much of a medication (overdose).
- Chronic Toxic Hepatitis: This is a condition that develops slowly over time. Sometimes it can take weeks, months, or even years for symptoms to appear. People who drink alcohol for a long time are more likely to develop this condition.
Also, there is a classification based on the cause of this condition. The table below can be used to clearly understand this.
| Type of Toxic Hepatitis (by cause) | A simple explanation |
|---|---|
| Drug-induced hepatitis | It is caused by excessive or incorrect use of medications prescribed by a doctor, painkillers purchased from the pharmacy, vitamins, or Ayurvedic/herbal medicines. |
| Alcohol-induced hepatitis | Excessive and prolonged alcohol consumption directly damages the liver, which can lead to liver inflammation. |
| Chemical-induced hepatitis | It is caused by the ingestion of toxic chemicals such as solvents, pesticides, and herbicides used in factories. |
What are the symptoms of liver damage?
The main and most familiar symptom of liver disease is yellowing of the eyes and skin. We also call this jaundice , and in medical terms it is called ``Jaundice.'' In addition to this, a number of other symptoms may occur.
- Pain in the right side of the abdomen, below the ribs
- Tiredness and fatigue
- Appetite
- Nausea and vomiting
- Low fever
- Dark yellow or brown urine
- Abdominal distension, or ascites
- Itching (Pruritus)
- Purple spots or patches on the skin
The important thing is that sometimes, especially in the case of `Chronic Toxic Hepatitis`, no symptoms may appear until the liver has been significantly damaged. Therefore, it is important to always be aware if there are risk factors.
What are the main causes of Toxic Hepatitis?
As we discussed earlier, there are several reasons. Let's look at them in a little more detail.
Medications and vitamins (Drug-induced hepatotoxicity)
This is a very common thing to see.
- Painkillers: Some painkillers, especially those that can be purchased over the counter at the pharmacy, for example, `(Acetaminophen)` (found in medicines like `Panadol` in Sri Lanka) and `(NSAIDs)` (Nonsteroidal anti-inflammatory drugs) (e.g. `Ibuprofen`, `Diclofenac`) can cause liver damage if taken in excess of the recommended dose.
- Prescription medications: Some medications, such as cholesterol-lowering medications, epilepsy medications, and antibiotics, can also affect the liver in some people. But don't stop taking your medications because of this. If you have any concerns, talk to your doctor about it.
- Herbal and Ayurvedic medicines: There is a perception in society that 'Sinhala medicine' or 'traditional things' do not cause any harm. But that is not entirely true. Some herbal medicines may contain ingredients that are harmful to the liver. Therefore, it is risky to use these without the advice of a qualified doctor.
- Vitamins: Excessive intake of some vitamins, such as vitamin A, can also be toxic to the liver.
Learn specifically about Acetaminophen poisoning
`Acetaminophen` is a medicine that we commonly use for fever and body aches. In Sri Lanka, it is available under names like `Panadol` and `Paramol`. Although this is a very safe medicine, it can cause severe damage to the liver if taken in excess of the prescribed dosage.
Imagine, someone takes two Panadol tablets for a headache. A few hours later, they take another packet from the pharmacy for a cold. They don't know that that packet also contains Acetaminophen. This way, they can unknowingly exceed the maximum daily dose.
In general, an adult should not take more than 4,000 milligrams of acetaminophen (that's 8 500mg tablets) in 24 hours. If you already have liver disease, this amount should be even lower. If you accidentally take too much medicine, even if you don't have any symptoms, go to a hospital's emergency department (ETU) immediately. If necessary, you can also call the National Poisons Information Center at the National Hospital for advice.
Alcohol use (Alcohol-induced toxic hepatitis)
Excessive alcohol consumption is a major cause of liver damage. Alcohol is a direct poison to liver cells. When alcohol is consumed over a long period of time, fat accumulates in the liver, which then becomes inflamed, and eventually the liver can become completely scarred and unable to function (Cirrhosis).
Who is at higher risk of developing this condition?
Although anyone can develop `Toxic Hepatitis`, some people are at higher risk.
- For women: Because women's bodies metabolize differently than men's, they are at slightly higher risk of liver damage from some medications and alcohol.
- For those who drink alcohol excessively.
- For those who already have another liver disease (e.g. Hepatitis B, Hepatitis C, Fatty Liver).
- For those who use several medications at the same time.
- For those who work with chemicals (e.g. paint industry, plastics industry, dry cleaning services).
- For people with certain genetic diseases (e.g. `Alpha-1 antitrypsin deficiency`, `Hemochromatosis`).
Can this be dangerous? What are the complications?
Yes, if Toxic Hepatitis is not treated promptly and the harmful substance is not removed, it can lead to serious complications. The main complication is cirrhosis of the liver.
Cirrhosis is a condition in which healthy liver cells are destroyed and replaced with scar tissue. This completely disrupts the normal functioning of the liver. Ultimately, this leads to liver failure . In such cases, the only life-saving option may be a liver transplant .
How does a doctor find this?
When you go to see a doctor, he will first ask you a lot of questions about your symptoms, the medications you take, whether you drink alcohol, and what your occupation is. Then he will examine your body. He may also do some tests to confirm the diagnosis.
- Blood tests:
- Liver Function Tests: These can check liver enzyme levels to see if there is liver damage.
- Comprehensive Metabolic Panel `(CMP)`: This test helps to gain a comprehensive understanding of the body's metabolic processes and organ function.
- Testing for alcohol or other drug levels.
- Other tests:
- Scans: A CT scan or MRI scan can visually check the condition of the liver.
- Liver Biopsy: In some cases, a small piece of tissue is taken from the liver using a very small needle and examined under a microscope. This can help determine the exact extent of the damage.
How is it treated? Can this be cured?
The best treatment for `Toxic Hepatitis` is to immediately avoid the substance that is damaging the liver. The treatment depends on the extent of the damage to the liver.
- Stopping the harmful medication: If your doctor suspects that a particular medication or vitamin is causing liver damage, he or she will advise you to stop taking it immediately.
- Complete cessation of alcohol.
- Changes in the workplace: If the condition is caused by chemicals, you may need to wear protective equipment (masks, gloves) at work or be transferred to another job.
- For an acetaminophen overdose: A special antidote is given in the hospital. If given quickly, this can prevent much of the damage to the liver.
The good news is that our liver has an amazing ability to regenerate. If the damage is not severe and the harmful substance is completely removed, the liver can heal itself within a few weeks or months. However, if the damage has progressed to the point of cirrhosis, it is difficult to reverse.
When should you see a doctor immediately?
If any of the following severe symptoms occur, it could be a sign of complete liver failure. Therefore , go to the nearest hospital Emergency Department (ETU) without delay.
- Vomiting blood.
- Black, tarry stools.
- Sudden appearance of bruise-like spots all over the body.
- Severe yellowing (Jaundice).
- Severe anorexia.
- Delirium, delusional state.
- Difficulty walking.
Take-Home Message
- Although our liver is the main organ that detoxifies our body, it is very sensitive to some things.
- Even a common painkiller can cause serious liver damage if taken in excess of the recommended dose. Read the label carefully and follow the instructions when using the medication.
- Alcohol is one of the liver's biggest enemies. Limiting or completely stopping alcohol consumption is very important for liver health.
- Not everything that is labeled 'herbal' or 'natural' is safe. Talk to your doctor before using any supplement or vitamin.
- If you suspect you have taken too much medicine or if you develop severe symptoms, go to a hospital's Emergency Department (ETU) immediately.
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