Georgetown University School of Medicine, Washington, DC.
Department of Emergency Medicine, New York Presbyterian-Columbia/Cornell, New York, NY.
J Emerg Med. 2021 May;60(5):610-614. doi: 10.1016/j.jemermed.2021.01.004. Epub 2021 Feb 10.
Acute liver injury is reported in association with toxins, pharmaceuticals, and viral infections. Increasingly prevalent are cases of herbal- and dietary supplement-related hepatotoxicity. Early recognition of this potentially life-threatening complication by emergency care providers leads to more appropriate management and disposition.
A 53-year-old woman presented to the emergency department with a 3-day history of jaundice and increased abdominal girth after a month-long use of a combination herbal "liver-cleansing" compound and a nightly herbal "sleep aid." The "Liver Detoxifier and Regenerator" listed multiple constituents, including concentrated scute root and turmeric root; "Restful Sleep" listed multiple constituents, including valerian. Emergency department evaluation revealed marked hyperbilirubinemia with liver enzyme elevations indicative of cholestatic jaundice. Imaging studies, including ultrasound and abdominal magnetic resonance imaging, revealed hepatomegaly and steatosis without biliary dilatation; a biopsy specimen was obtained, and the results were consistent with drug-induced liver injury. The patient's liver function abnormalities gradually improved with discontinuation of the products as well as a tapered course of corticosteroid therapy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: A significant proportion of the U.S. adult population uses herbal and dietary supplements. Most patients do not discuss nonprescription medication use with their providers and many physicians will not specifically ask about herbal supplements. It is important for emergency physicians to be aware of the potential for herbal supplements to contribute to acute liver injury and be able to investigate the active agents reported in these formulations. The diagnostic criteria for cholestatic jaundice and drug-induced liver injury are discussed.
急性肝损伤与毒素、药物和病毒感染有关。越来越多的病例与草药和膳食补充剂相关的肝毒性有关。急诊医护人员早期识别这种潜在的危及生命的并发症，可导致更恰当的管理和处置。
一名 53 岁女性因黄疸和腹胀增加，在使用一种组合的草药“肝脏清洁”化合物和一种每晚的草药“助眠”产品一个月后，出现了 3 天的病史。“肝脏解毒剂和再生剂”列出了多种成分，包括浓缩的虎杖根和姜黄根；“安睡”列出了多种成分，包括缬草根。急诊评估显示显著的高胆红素血症和肝酶升高，提示为胆汁淤积性黄疸。影像学研究，包括超声和腹部磁共振成像，显示肝肿大和脂肪变性，但没有胆管扩张；获得了活检标本，结果与药物性肝损伤一致。患者的肝功能异常随着产品的停用以及皮质类固醇的逐渐减量而逐渐改善。
为什么急诊医生应该了解这一点？：相当一部分美国成年人口使用草药和膳食补充剂。大多数患者不会与他们的提供者讨论非处方药的使用情况，许多医生也不会专门询问草药补充剂的情况。急诊医生应该意识到草药补充剂可能导致急性肝损伤，并能够调查这些配方中报告的活性药物。讨论了胆汁淤积性黄疸和药物性肝损伤的诊断标准。
