Clinical Spectrum and Outcome of Pediatric Drug Induced Liver Injury

Kumar, Aditi; Sood, Vikrant; Khanna, Rajeev; Verma, Sanjeev Kumar; Mehra, Nikhil; Rawat, Dinesh; Alam, Seema

doi:10.1007/s12098-017-2570-3

Cited by 14 publications

(11 citation statements)

References 10 publications

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“…They would also compare favorably to Kumar and colleague’s report, where 11% of pediatric patients had a DILI-related death, and 14% went on to develop chronic disease. However, this report was notable in that three-fourths of cases were caused by complementary and alternative medicines and anti-tuberculosis agents 18 . These agents were not identified in our population.…”

Section: Discussionmentioning

confidence: 74%

An electronic medical records-based approach to identify idiosyncratic drug-induced liver injury in children

Sandritter

Goldman

Habiger

et al. 2019

Sci Rep

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Drug-induced liver injury (DILI) is the leading cause of liver failure in the United States and the most common cause of drug recall. As opposed to the recognized direct toxicity of super-therapeutic acetaminophen or chemotherapeutic agents in children, limited data exists for pediatric populations on the incidence of idiosyncratic DILI (iDILI) that may develop independently of drug dose or duration of administration. To improve the detection of adverse drug reactions at our hospital, we utilized electronic medical records-based automated trigger tools to alert providers of potential iDILI. Clinical criteria concerning for iDILI were defined as serum ALT > 5x or serum bilirubin > 1.5x upper limit of normal in the setting of medication exposure. Over a two year period, 12 patients were identified as having possible or probable iDILI. Out of the identified patients, three were males, and the mean age was 10.8 years. Implicated agents included eight antibiotics, two anti-epileptics, one anti-psychotic, and one anti-inflammatory medication. Roussel-Uclaf Causality Assessment Methods identified one “possible” case, 11 “probable” cases, and one “highly probable” case of iDILI. Improved awareness and more vigilant programming can generate better data on iDILI and improve our understanding of the condition and its incidence in children.

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Section: Discussionmentioning

confidence: 74%

An electronic medical records-based approach to identify idiosyncratic drug-induced liver injury in children

Sandritter

Goldman

Habiger

et al. 2019

Sci Rep

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“…Analgésico, Antipirético, Antiinflamatório não esteroidal Acetaminofeno (Kumar et al, 2018;Hedeland et al, 2014), Ibuprofeno (Hita, 2013) e não especificado (Zhu et al, 2015) Antiarrítmico Sotalol (Zhu et al, 2015) e não especificado (Hita, 2013) Antiasmático Não especificado (Zhu et al, 2015) Antibiótico Amoxacilina (Hita et al, 2013), Amoxicilina + Clavulanato de Potássio (Hita et al, 2012;DiPaola et al, 2019;Kumar et al, 2018;Hita, 2013)…”

Section: Classe Representantesunclassified

“…Não especificado (Zhu et al, 2015) Antitireoidiano Propiltiouracil (Rivkees;Szarfman, 2010;Hita et al, 2013) Antiviral Aciclovir (Hita et al, 2013), Antirretroviral (Gil et al, 2007) e não especificado (Zhu et al, 2015) Glicocorticoide Não especificado (Zhu et al, 2015) Imunossupressor Tacrolimus (Ganschow et al, 2006) Psicotrópicos Atomoxetina (DiPaola et al, 2019), Fluoxetina (DiPaola et al, 2019) e Metilfenidato (DiPaola et al, 2019 Tuberculostático Etambutol (LiverTox, 2012), Isoniazida (Kumar et al, 2018;Hita et al, 2013;Gil et al, 2007;Ruslami et al, 2022;Le Roux et al, 2013), Rifampicina (Kumar et al, 2018;Hita et al, 2013;Gil et al, 2007;Ruslami et al, 2022) e Pirazinamida (Kumar et al, 2018;Ruslami et al, 2022) Outros Ácido Ascórbico (Zhu et al, 2015), Ácido Nicotínico (DiPaola et al, 2019, Ervas (Zhu et al, 2015;Hita et al, 2013), Etnilestradiol (DiPaola et al, 2019 e Termogênicos (DiPaola et al, 2019) Fonte: Autores.…”

Section: Antiparasitáriounclassified

Injúria hepática induzida por medicamentos em pacientes pediátricos

Iwaki

Gonçalves

Louro

et al. 2023

RSD

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A injúria hepática induzida por medicamentos (DILI – que vem do inglês Drug Induced Liverr Injury) consiste numa lesão ocasionada por medicamentos, ervas e xenobióticos, que levam a alterações hepáticas. A incidência de DILI na pediatria é desconhecida, pois casos são subclínicos ou subnotificados. O objetivo deste trabalho foi realizar uma revisão da literatura para identificar os principais medicamentos envolvidos em DILI na pediatria. Foram identificados 339 artigos nas bases de dados, sendo que 48 foram selecionados para leitura na íntegra e após seleção e elegibilidade totalizou-se 13 artigos. A DILI na pediatria é um desafio pela vasta clínica, diagnóstico difícil e tratamento inespecífico. Foi verificada elevada e heterogênea possibilidade de fármacos que causam dano hepático em crianças. É importante que estudos sejam realizados para garantir melhores resultados quanto ao diagnóstico, prevenção e tratamento, assim como a organização de bancos de dados com informações sobre eventos adversos hepáticos envolvendo o uso de medicamentos na pediatria.

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“…Conversely, complementary/alternative drugs and anti-tubercular agents have been reported as prevalent groups of drug implicated in DILI in India (39% and 33%, respectively) [17]. Furthermore, chinese herbal medicine represents the main etiological agent of pediatric DILI in China [15].…”

Section: Associated Drugsmentioning

confidence: 99%

Drug-Induced Liver Injury in Paediatrics: A Short Review

Tei

Lotti

Storelli

et al. 2022

Int. J. Pediatr. Child Health

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Drug-induced liver injury (DILI) is an under-recognized cause of paediatric liver disease. Although DILI in children accounts for about 1% of all reported adverse drug reactions throughout all age groups and less than 10% of all clinical DILI cases, it is responsible for about 20% of acute liver failure (ALF) cases. A wide range of drugs, herbal products and nutritional supplements have been associated with the development of DILI through dose-dependent, idiosyncratic or indirect mechanism. Limited literature is available in pediatric population, making DILI a still challenging diagnosis. An accurate medical history is of pivotal importance and should investigate about drug consumption, clinical and laboratory findings, individual and family risk factors for drug-related side effects or comorbidities, the timing of the injury onset after the implicated agent has been started (latency). Clinical presentation of DILI varies from asymptomatic or very mild to serious and sometimes fatal conditions; laboratory tests may be helpful in ruling out other causes of liver injury but, with few exceptions, they are aspecific. Early suspicion and prompt withdrawal of the offending drug play a key role for a successful management of most cases. Rarely a specific therapy is available, as for acetaminophen toxicity, treated with N-acetylcysteine, and sodium valproate toxicity, where carnitine may be beneficial. Although controlled trials are not available yet, corticosteroids and ursodeoxycholic acid can be considered if no improvement is proven after discontinuation of drug. The present short review is not intended to deal with all aspects concerning DILI but to focus on epidemiology, pathogenesis, clinical features, practical management and current challenges in paediatric age.

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Clinical Spectrum and Outcome of Pediatric Drug Induced Liver Injury

Cited by 14 publications

References 10 publications

An electronic medical records-based approach to identify idiosyncratic drug-induced liver injury in children

An electronic medical records-based approach to identify idiosyncratic drug-induced liver injury in children

Injúria hepática induzida por medicamentos em pacientes pediátricos

Drug-Induced Liver Injury in Paediatrics: A Short Review

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