Drug-Induced Liver Injury

  • Dennis L. Shung
  • Joseph K. LimEmail author


Drug-induced liver injury (DILI) accounts for about 50% of acute liver failure cases in the United States. Diagnosis is challenging, especially due to the myriad combinations of potentially hepatotoxic medications and clinical presentations. Unexplained liver injury should prompt a thorough investigation of medication administration (e.g., for accidental or intentional overdose) and the use of herbal and dietary supplements. The framework for approaching DILI includes the following: (1) categorize the injury as either intrinsic or idiosyncratic, (2) establish time course and pattern of injury, and (3) triage effectively to minimize mortality risk.


Drug-induced liver injury Medications Hepatotoxicity Abnormal liver enzymes Acetaminophen Hy’s law 

Further Reading

  1. 1.
    Chalasani NP, et al. ACG clinical guideline: the diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol. 2014;109:950–66.CrossRefGoogle Scholar
  2. 2.
    Kwo PY, Cohen SM, Lim JK. ACG practice guideline: evaluation of abnormal liver chemistries. Am J Gastroenterol. 2017;112(1):18–35.Google Scholar
  3. 3.
    Lee WM. Drug-induced hepatotoxicity. NEJM. 2003;349:474–85.CrossRefGoogle Scholar
  4. 4.
    Lee WM, Stravitz RT, Larson AM. Revised American Association for the Study of Liver Diseases position paper on acute liver failure. Hepatology. 2012;55(3):965–7.CrossRefGoogle Scholar
  5. 5.
    Reuben A, Koch DG, Lee WM. Drug-induced acute liver failure: results of a U.S. multicenter, prospective study. Hepatology. 2010;52:2065–76.CrossRefGoogle Scholar
  6. 6.
    Stravitz RT, et al. Autoimmune acute liver failure: proposed clinical and histological criteria. Hepatology. 2011;53:517–26.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Section of Digestive Diseases, Department of MedicineYale-New Haven HospitalNew HavenUSA
  2. 2.Section of Digestive DiseasesYale University School of MedicineNew HavenUSA

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