Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ INTRODUCTION ++Table Graphic Jump LocationTABLE A6-1An Approach to Evaluating a Suspected Hepatotoxic ReactionView Table||Download (.pdf) TABLE A6-1 An Approach to Evaluating a Suspected Hepatotoxic Reaction Points −3 −1 0 +1 +2 +3 What is the temporal relationship? (days) From the start of therapy – – ?? <5 >90 5–90 From the end of therapy >30 – ?? – – <30 Is there evidence of the concurrent use of a hepatotoxina Yes Maybe ?? – – No Is there an alternate cause, such as, viral hepatitis? Yes Most likely—Yes ?? Most likely—No No Are there extrahepatic signs or symptoms? Dermatologic: rash, palmar erythema, cutaneous vasculitis – – No Yes (+1 for each) – – Dermatologic: spider nevi, white nails (aka Terry nails) – – No Yes (+1 for each) – – Hematologic: coagulation disorders – – No Yes (+1 for each) – – Endocrine disorders: insulin resistance, thyroid dysfunction – – No Yes (+1 for each) – – Endocrine disorders: adrenal insufficiency, hypogonadism – – No Yes (+1 for each) – – Skeletal muscular: arthralgias, arthritis – – No Yes (+1 for each) – – Neurological: encephalopathy – – No Yes (+1 for each) – – Portopulmonary hypertension – – No Yes (+1 for each) – – Does the literature support a connection with this drug? Listed in the product labeling – – – – – Yes Published reports in the literature – – – – Yes – No information available, reaction is undocumented – – Yes – – – −3 +4 Results from a rechallenge with the drug. Negative – – – – Positive adrug, herbal remedy, or other occupational exposure known to be potentially hepatotoxic.A total score of <7 makes it unlikely that this is a hepatotoxic reaction. As the score approaches 14, the possibility that this is a hepatotoxic reaction increases toward certainty. ?? = uncertain. ++Table Graphic Jump LocationTABLE A6-2Environmental Hepatotoxins and Associated Occupations at Risk for ExposureView Table||Download (.pdf) TABLE A6-2 Environmental Hepatotoxins and Associated Occupations at Risk for Exposure Hepatotoxin Associated Occupations at Risk for Exposure Arsenic Chemical plant, agricultural workers Carbon tetrachloride Chemical plant workers, laboratory technicians Copper Plumbers, sculpture artists, foundry workers Dimethylformamide Chemical plant workers, laboratory technicians 2,4-Dichlorophenoxyacetic acid Horticulturists Fluorine Chemical plant workers, laboratory technicians Toluene Chemical plant, agricultural workers, laboratory tech Trichloroethylene Printers, dye workers, cleaners, laboratory technicians Vinyl chloride Plastics plant workers; also found as a river pollutant ++Table Graphic Jump LocationTABLE A6-3Relative Patterns of Hepatic Enzyme Elevation versus Type of Hepatic LesionView Table||Download (.pdf) TABLE A6-3 Relative Patterns of Hepatic Enzyme Elevation versus Type of Hepatic Lesion Enzyme Abbreviations Necrotic Cholestatic Chronic Alkaline phosphatase Alk Phos, AP ↑ ↑↑↑ ↑ 5′-Nucleotidase 5-NC, 5NC ↑ ↑↑↑ ↑ γ-Glutamyltransferase GGT, GGTP ↑ ↑↑↑ ↑↑ Aspartate aminotransferase AST, SGOT ↑↑↑ ↑ ↑↑ Alanine aminotransferase ALT, SGPT ↑↑↑ ↑ ↑↑... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth