a. Toxic hepatitis (acute liver cell necrosis) is caused by ingestion, inhalation, or injection of certain chemicals (hepatotoxins) that have a poisonous effect on the liver.

Examples include carbon tetrachloride, phosphorus, chloroform, vinyl chloride, and poisonous mushrooms.

(1) Signs and symptoms include anorexia, nausea, vomiting, jaundice, and hepatomegaly.

(2) Liver damage occurs within 24-48 hours, depending on the dose of the toxin.

(3) For recovery to occur, the toxin must be identified and removed as soon as possible.

b. Drug induced hepatitis is an idiosyncratic reaction to a drug due to hypersensitivity. Examples include sulfonamides, isoniazid, and halothane.

(1) Symptoms may appear any time during or after exposure to the drug, but usually appear after 2-4 weeks of therapy.

(2) Onset is generally abrupt, with chills, fever, anorexia, nausea, rash, and pruritis. Jaundice and hepatomegaly may occur later.

(3) Symptoms subside when the offending drug is removed.

c. Nursing implications.

(1) Care is symptomatic and supportive in nature.

(2) Patient education should be reinforced regarding proper handling of chemicals, cleaning agents, solvents, and so forth, as applicable.

(3) Nursing personnel, pharmacists, and physicians should alert patients to medication side effects. If fever, rash, or pruritis result from any medication, it should be stopped at once and the prescribing physician consulted.

(4) Patients with known liver disease should not receive halothane as an anesthetic.