Twee patiënten met acute toxische hepatitis na recente inname van thee

Two patients with toxic hepatitis after tea ingestion Drug-induced liver injury (DILI) is common and can manifest in various degrees: from asymptomatic increased transaminases to hepatocellular jaundice with an elevated total and direct bilirubin to acute liver failure. When accompanied by jaundice, there is a mortality rate of 10%. In acute liver failure, referral to a tertiary centre is necessary. This article emphasizes the consideration of herbal and dietary supplements (HDS). The use of HDS in Europe and the US is rising. Some studies state that 1 out of 3 to 1 out of 2 Americans take dietary supplements, which raises concerns about HDS-related toxic hepatitis. HDS involve any supplement that could cause liver damage, including herbs, vitamins, minerals, amino acids and proteins. The prevalence of hepatotoxicity is underestimated. DILI is a diagnosis of exclusion. Diseases that should be excluded, are viral hepatitis, non-alcoholic steatohepatitis (NASH), alcoholic steatohepatitis (ASH), hereditary hemochromatosis, autoimmune hepatitis, Wilson’s disease and alpha-1 antitrypsin deficiency. If there is an increased total and direct bilirubin with or without cholestasis, bile duct stones and hepatobiliary malignancies should be excluded. A liver biopsy may be necessary if the diagnosis is unclear or when several diagnoses are plausible. Liver damage usually occurs within 1 to 6 months after starting the product and is usually reversible. It is important to bear in mind HDS when considering DILI as the incidence of HDS is clearly increasing.