Hepatitis liver function tests

A 57-year-old woman developed hepatitis 2 months after starting to take acarbose 100 mg tds (59). No other causes of hepatitis were found. Liver function tests normalized 3 months after withdrawal. Acarbose was reintroduced 3 years later and she again developed acute hepatitis. Liver function tests became normal 2 months after withdrawal. 

A 52-year-old man presented with jaundice and pruritus over the last 10 days after taking the boiled Equisetum Arvense Herba juice (500 ml per day) for her renal colic complaints for the last 2 weeks. Liver function tests revealed alanine aminotransferase of 818 U/L, aspartate aminotransferase of 1117 U/L, and alkaline phosphatase of 298 U/L. It was found that the patient had Child-Pugh A chronic liver disease due to hepatitis B virus. There was a temporal relationship between drinking EA juice and severe hepatitis. Liver function tests data elevated dramatically 2 weeks after starting to drink EA juice. It was suspected that the presence of the underlying chronic liver disease secondary to hepatitits B infection may have predisposed the patient to EA-induced hepatotoxicity. His liver function tests data returned completely to the pre-admission levels 8 weeks after withdrawal of the E A juice. 

The dosage of flucytosine is 150—200 mg/kg orally in four portions every six hours. A 1% flucytosine solution has been developed for intravenous adrninistration. In some countries, a 10% ointment is also available. In patients with normal renal function, flucytosine is seldom toxic, but occasionally severe toxicity may be observed (leukopenia and thrombocytopenia). Plasma levels should be determined and the dose in patients with impaired renal function should be checked. Liver function tests (transaininases and alkaline phosphatase) should be performed regularly. In some patients with high flucytosine plasma levels, hepatic disorders have been observed (24). 

PYRAZINAMIDE Patients should have baseline liver functions tests to use as a comparison when monitoring liver function during pyrazinamide therapy. The nurse should monitor the patient closely for symptoms of a decline in hepatic functioning (ie, yellowing of the skin, malaise, liver tenderness, anorexia, or nausea). The primary health care provider may order periodic liver function tests. Hepatotoxicity appears to be dose related and may appear at any time during therapy. 

ITRACONAZOLE Although rare, die patient may develop hepatitis during itraconazole administration. The nurse closely monitors die patient for signs of hepatitis, including anorexia, abdominal pain, unusual tiredness, jaundice, and dark urine. The primary healtii care provider may order periodic liver function tests. 

Hepatic Effects. Normal serum liver function tests (unspecified) were observed in a 35-year-old agricultural pilot approximately 8 hours after a 45-minute dermal exposure (with presumed concurrent inhalation exposure) when his clothing became soaked in endosulfan and methomyl (Cable and Doherty 1999). 

Hepatic Effects. Jaundice and abnormal liver function tests including increases in serum transaminase levels have been reported in individuals occupationally exposed to trichloroethylene by both dermal and inhalation exposure (Bauer and Rabens 1974 Phoon et al. 1984). 

Diagnosing viral hepatitis may be difficult because most infected individuals are asymptomatic. Because symptoms cannot identify the specific type of hepatitis, laboratory serologies must be obtained (Table 21-2). In addition, liver function tests may be obtained to assess the extent of cholestatic and hepatocellular injury. However, the definitive test to determine the amount of damage and inflammation of hepatic cells is a liver biopsy. 

Carbamazepine Manufacturer recommends CBC and platelets (and possibly reticulocyte counts and serum iron) at baseline, and that subsequent monitoring be individualized by the clinician (e.g., CBC, platelet counts, and liver function tests every 2 weeks during the first 2 months of treatment, then every 3 months if normal). Monitor more closely if patient exhibits hematologic or hepatic abnormalities or if the patient is receiving a myelotoxic drug discontinue if platelets are less than 100,000/mm3, if white blood cell (WBC) count is less than 3,000/mm3 or if there is evidence of bone marrow suppression or liver dysfunction. Serum electrolyte levels should be monitored in the elderly or those at risk for hyponatremia. Carbamazepine interferes with some pregnancy tests. 

TC, lamivudine ABC, abacavir APV, amprenavir AST, aspartate aminotransferase ALT, alanine aminotransferase ATV, atazanavir CBC, complete blood cell count D/C, discontinue ddl, didano-sine d4T, stavudine EFV, efavirenz FTC, emtricitabine P1BV, hepatitis B virus F1CV, hepatitis C vims HIV, human immunodeficiency virus IDV, indinavir IV, intravenous LFT, liver function tests LPV/r, lopinavir + ritonavir NNRTI, nonnucleoside reverse transcriptase inhibitor NRTI, nucleoside reverse transcriptase inhibitor NVP, nevirapine PI, protease inhibitor PT, prothrombin time T.bili, total bilirubin TDF, tenofovir disoproxiI fumarate TPV, tipranavir ULN, upper limit of normal ZDV, zidovudine. 

For HIV HIV RNA, baseline HIV genotypic resistance test For HIV treatment Hepatitis B tests (hepatitis B surface antibody and antigen, hepatitis B envelope antigen, and HBV DNA), liver function tests... 

Fever, rigors, chills, malaise headaches, myalgia Nausea, emesis Neutropenia Hepatic enzyme elevation Cutaneous—alopecia, transient, mild rashlike reaction Acetaminophen (APAP). NSAID if APAP is not effective. Meperidine for severe chills and rigors. Bedtime administration. 5-HT3 antagonist, prochlorperazine, metoclopramide, fluids Weekly complete blood count reduce dose by 30-50% Liver function tests (LFTs) weekly withhold treatment until LFTs normalize restart at 30-50% dose reduction reversible on dose reduction or cessation. Interferon is contraindicated in patients with psoriasis because exacerbation of psoriasis has been noted during IFN therapy. 

Amiodarone Tremor, ataxia, pareslfresia, insomnia, corneal microdeposits, optic neuropathy/neuritis, nausea, vomiting, anorexia, constipation, TdP (<1%), bradycardia or AV block (IV and oral use), pulmonary fibrosis, liver function test abnormalities, hepatitis, hypothyroidism, hyperthyroidism, photosensitivity, bluegray skin discoloration, hypotension (IV use), phlebitis (IV use)... 

Potentially important laboratory abnormalities occurring with niacin therapy include elevated liver function tests, hyperuricemia, and hyperglycemia. Niacin-associated hepatitis is more common with sustained-release preparations, and their use should be restricted to patients intolerant of regular-release products. Niacin is contraindicated in patients with active liver disease, and it may exacerbate preexisting gout and diabetes. 

The starting and recommended dose of tolcapone is 100 mg three times daily as an adjunct to carbidopa/L-dopa. Its use is limited by the potential for fatal liver toxicity. Strict monitoring of liver function is required, and tolcapone should be discontinued if liver function tests are above the upper limit of normal or any signs or symptoms suggestive of hepatic failure exist. It should be reserved for patients with fluctuations that have not responded to other therapies. 

Cholestatic hepatitis has been reported with risperidone, and liver function test abnormalities (mostly transient) have been reported with olanzapine and clozapine. 

Hepatic Effects. Liver function tests (serum bilirubin, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase) completed in 11 hexachloroethane workers were within the normal range (Selden et al. 1994). Plasma hexachloroethane levels in these workers, who wore protective equipment, were 7.3 + 6.04 pg/L at the time of the tests (Selden et al. 1993). Mild skin and mucous membrane irritation were reported in the exposed group, suggesting that exposure may have been through either the inhalation or dermal routes of exposure. 

Hepatic Effects. Liver function tests (serum bilirubin, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase) were not affected in 11 hexachloroethane-exposed workers who wore protective clothing (Selden et al. 1993). 

Determination of the level of cytosolic enzymes such as aspartate transaminase, alanine transaminase, and lactate dehydrogenase is part of standard biochemical liver function tests to measure hepatocellular necrosis [2, 101]. Cytosolic enzymes are not subject to genetic variations inherent in microsomal enzyme production. Liver cytosolic enzymes metabolize several molecules, of which galactose and amino acids are typical examples, used for hepatic function tests. 

Hepatic Effects. No studies were located regarding hepatic effects in humans after dermal exposure to 1,3,5-TNB. In one case report of occupational exposure to 1,3-DNB (Ishihara et al. 1976), the exposed worker had palpable liver while her liver function tests were negative. This study is limited in that only a single case was described and functional tests were performed 10 days after the exposure. 

Some studies of occupationally exposed groups have revealed evidence of liver injury by serum enzyme studies or other liver function tests. Adverse effect and dose-effect relationships have not been consistent within and between studies, raising the possibility that other factors (e.g., alcohol intake, other exposures) could be responsible. Review of these studies indicates that some liver effects may have occurred with repeated exposures at concentrations below O.lmg/m assuming RGBs were responsible. Several deaths due to toxic hepatitis have been reported among workers exposed to mixtures of RGBs with chlorinated naphthalenes such effects have not been observed with PGB exposure alone. ... 

Hepatomegaly, jaundice, and altered liver function tests have been reported in accidental poisonings with DME An outbreak of toxic liver disease was associated with DME exposure at a fabric coating factory. Thirty-six of 58 workers had elevations of either aspartate aminotransferase or alanine aminotransferase. Serological tests excluded known infectious causes of hepatitis in all but two cases. After modification of work practices and removal of the most severely affected from exposure, improvement in liver enzyme abnormalities and symptoms occurred in most patients. Medical surveillance of the working population for 14 months revealed no further cases of toxic liver... 

Hepatic dysfunction Hepatic dysfunction has been reported perform periodic liver function tests. 

Hepatic function impairment Since mexiletine is metabolized in the liver, and hepatic impairment prolongs the elimination half-life, carefully monitor patients with liver disease. Observe caution in patients with hepatic dysfunction secondary to CHF. Abnormal liver function tests have been reported, some in the first few weeks of therapy with mexiletine. Most have occurred along with CHF or ischemia their relationship to mexiletine has not been established. 

Hepatotoxicity Fever has occasionally occurred within the first 3 weeks of therapy, sometimes associated with eosinophilia or abnormalities in 1 liver function test or more. Jaundice with or without fever may occur, usually within the first 2 to 3 months of therapy. Incidence of elevated serum transaminase levels and impaired hepatic function ranges from 1% to 27%. 

Monitoring Blood count, Coombs tests, and liver function tests are recommended before initiating therapy and at periodic intervals. Perform periodic determinations of hepatic function, particularly during the first 6 to 12 weeks of therapy or when an unexplained fever occurs. 

Hepatotoxicity Rarely, elevations of 1 or more liver enzymes have occurred in patients receiving zafirlukast. Most of these have been observed at doses 4 times higher than the recommended dose. The following hepatic events predominantly in females) have been reported in patients who have received the recommended dose of zafirlukast (40 mg/day) Cases of symptomatic hepatitis without other attributable cause and, rarely, hyperbilirubinemia without other elevated liver function tests. In most, symptoms abated and the liver enzymes returned to healthy or near healthy after stopping zafirlukast. If liver dysfunction is suspected, discontinue zafirlukast. Eosinophilia Physicians should be alert to eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, or neuropathy presenting in their patients. In rare cases, patients on zafirlukast therapy may present with systemic eosinophilia. These events usually, but not always, have been associated with the... 

Hepatic effects Borderline liver function test elevations may occur in about 15% of patients and may progress, remain essentially unchanged, or become transient with continued therapy. 

Hepatic complications Perform periodic liver function tests, such as bilirubins, alkaline phosphatase, or transaminases during therapy discontinue at the first sign of hepatic dysfunction or jaundice. 

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