Medical history (history of illness) represents an important component in the diagnosis of liver failure. Family history
- Is there a history of frequent liver disease in your family?
Social history
Current medical history/systemic history (somatic and psychological complaints).
- Do you suffer from any brain dysfunction?
- Disturbance of consciousness*
- Euphoria, depression*
- Insomnia (sleep disorders)
- Confusion*
- Have you noticed yellowing of the skin and/or eyes?
- Have you or anyone else noticed that your breath smells like raw liver?
- Do you have a coarse hand tremor?
- Have you noticed bleeding disorders, i.e. prolonged bleeding from wounds?
- Do you suffer from abdominal dropsy? (abdominal girth increase due tofluid accumulation in the free abdominal cavity)* .
- Do you suffer recently increased low blood pressure (eg, dizziness, tendency to collapse, fatigue, cold hands, etc.).
- Have you noticed that you have excessive breathing?
Vegetative history including nutritional history.
- Have you recently consumed mushrooms or similar?
- Have you been abroad recently?
- Have/had unprotected sexual intercourse?
- Do you smoke? If yes, how many cigarettes, cigars, or pipes per day?
- Do you drink alcohol? If yes, what drink(s) and how many glasses per day?
- Do you use drugs? If yes, what drugs (ecstasy, cocaine) and how often per day or per week?
Self history incl. drug history.
- Pre-existing conditions (liver disease, infections, metabolic diseases).
- Operations
- Allergies
- Pregnancy history (HELLP syndrome (H = hemolysis/dissolution of erythrocytes (red blood cells) in the blood), EL = elevated liver enzymes, LP = low platelets)?)
- Environmental history
- Tuber leaf fungus intoxication (amanitins).
- Carbon tetrachloride
Medication history
- Allopurinol
- Analgesics (incl. NSAIDs)
- Acetylsalicylic acid (ASA), diclofenac, ibuprofen, indometacin, metamizole, acetaminophen* (paracetamol), sulindac* Non-alcoholic fatty liver (NAFLD)/non-alcoholic steatohepatitis (NASH) may potentiate the hepatotoxic effects of certain drugs, e.g., acetaminophen. However, for many potentially hepatotoxic drugs, no robust data currently exist on the impact on NAFL/NASH that would limit their use. (strong consensus)
- Flupirtine (nonopioid analgesic) [Pharmacovigilance Risk Assessment Committee (PRAC) recommends withdrawal of marketing authorization, 2018]
- Antiarrhythmic drugs – amiodarone
- Antibiotics
- Aminoglycoside antibiotics (gentamycin).
- Aminopenicillins (amoxicillin) – especially common combination: amoxicillin and clavulanic acid.
- Clavulanic acid
- Gyrase inhibitors – quinolones: ciprofloxacin, levofloxacin, moxifloxacin.
- Isoxazolylpenicillins (so-called staphylococcal penicillins) – oxacillin.
- Ketolides
- Lincosamide antibiotics (lincosamides) – clindamycin
- Macrolide antibiotics (macrolides) – azithromycin, clarithromycin, erythromycin.
- Nitroimidazoles (metronidazole).
- Nitrofurantoin
- Penicillins (flucloxacillin)
- Sulfonamides (sulfasalazine, synonym: salazosulfapyridine).
- Tetracyclines (doxycycline, minocycline).
- Trimethoprim / sulfamethoxazole)
- Antidepressants
- Dual-serotonergic antidepressants (DSAs) – nefazodone
- Melatonin receptor agonists (MT1/MT) and serotonin 5-HT2C receptor antagonists – agomelatine; contraindicated in patients 75 years of age and older.
- Noradrenergic and specific serotonergic antidepressants (NaSSA) – mirtazapine.
- Selective serotonin reuptake inhibitors (SSRIs) – fluoxetine, paroxetine, sertraline, trazodone.
- Selective dopamine and norepinephrine (slightly also serotonin) reuptake inhibitors (NDRI) – bupropion.
- Tricyclic antidepressants (TCAs) – amitriptyline
- Antiepileptic drugs – carbamazepine, valproate.
- Antihistamines – cyproheptadine
- Antihypertensives – alphamethyldopa, nifedipine, diltiazem, lisinopril, fosinopril, captopril, enalapril,verapamil, losartan, irbesartan.
- Anticoagulants
- Phenprocoumon (product names: Marcumar, Falithrom), Clopidogrel.
- New oral anticoagulants (NOAK, NOAC; direct oral anticoagulants, DOAK).
- Direct factor Xa inhibitor (apixaban, edoxaban, rivaroxaban).
- Direct and selective factor Xa inhibitor (apixaban).
- Selective thrombin inhibitor (dabigatran).
- Anticonvulsants – valproic acid/valproate, carbamazepine, gabapentin, phenopbarbital, phenytoin.
- Antifungals
- Allylamines (terbinafine)
- Ketoconazole (Ketoconazole)
- Polyene macrolactone (amphotericin, liposomal amphotericin B).
- Antipsychotics (neuroleptics) – carbamazepine, chlorpromazine, phenobarbital, phenothiazines, phenytoin, risperidone, valproic acid.
- Antituberculostatics – isoniazid, pyrazinamide, rifampicin, rifabutin.
- Α-Methyldopa
- Chloral hydrate
- Disulfiram (INN), also tetraethylthiuram disulfide (TETD).
- Drugs
- Ecstasy (collective name for a variety of phenylethylamines).
- Cocaine
- EGFR tyrosine kinase inhibitor – lapatinib
- Endothelin receptor antagonists (endothelin receptor antagonists) – ambrisentan, bosentan.
- HMG-CoA reductase inhibitors (statins), unspecified.
- Hormones
- Anabolic steroids (anabolic steroids)
- Antiestrogens (tamoxifen)
- Estrogens (ethinyl estradiol, estradiol)
- Oral anticonceptives, unspecified.
- Progesterone modulator ulipristal (ulipristal acetate).
- Testosterone
- Immunosuppressants
- Azathioprine, ciclosporin (cyclosporin A), daclizumab, fingolimod, mercaptopurine, natalizumab, teriflunomide.
- Immune checkpoint inhibitors against PD-1, PD-L1, and CTLA-4.
- Pirfenidone drug-induced liver injury (DILI) including cases with fatal outcomes.
- Intestinal anti-inflammatory drug (sulfasalcin).
- Motilin agonist
- Anesthetic (halothane)
- Norepinephrine reuptake inhibitor (atomoxetine).
- Oral antidiabetic agents – acarbose
- Orlistat
- Petadolex (butterbur) [rare].
- Phytopharmaceuticals – e.g., kava kava, Usnea barbata, celandine.
- Psychotropic substances such as modafinil [alkaline phosphatase ↑, gamma-GT ↑).
- Pyrrolizidine alkaloids (phytochemical).
- Thyrostatic drugs (thiamazole, carbimazole).
- Tyrosine kinase inhibitors (TKi) – bosutinib, nintedanib.
- Uricostats (febuxostat)
- Vitamins
- Vitamin B3 (niacin) > 500 mg/d (NRV: 16 mg; safe daily maximum for nicotinic acid is 10 mg).
- Antivirals
- Cytostatic drugs – anthracyclines, cytarabine, dacarbazine, flutamine, isoniazid, methotrexate (MTX), temozolomide (up to organ failure).
- Other – hypertonic saline, vitamin A intoxication, Thorotrast.
Researchers at the University of Iceland in Reykjavik had analyzed all cases of drug-induced liver injury over two years in their study. They found that, on average, 19 out of every 100,000 residents suffered liver damage from medications each year. The drugs that frequently affected the liver included paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), as well as antibiotics. For example, the combination of amoxicillin and clavulanic acid was responsible for 22% of damage
Environmental exposures – intoxications
- Tuber leaf fungus intoxication (amanitins).
- Carbon tetrachloride
* If this question has been answered with “Yes”, an immediate visit to the doctor is required!(data without guarantee)