Toxic Hepatitis

What is it?

Toxic hepatitis is an acute or chronic condition where liver cells (hepatocytes) are affected. The pathology is caused by the exposure to a substance toxic to the liver either once in high concentration or in small doses over a long period. Interaction with toxins found in household chemicals, alcohol, and medications can lead to a potentially fatal complication – hepatocyte damage. Toxic hepatitis involves inflammation and cell death in the liver, which without timely and proper treatment can be irreversible. Therapy takes place in a hospital setting, requiring the use of antidotes, blood filtration devices, and supportive medications.

The pathogenesis of the disease is associated with lipid peroxidation, protein denaturation, depletion of ATP reserves, disruption of mitochondrial function, and destruction of the cellular skeleton of membrane receptors.

About the Disease

All chemical substances that enter the bloodstream are bound and neutralized by the liver. However, increased functional load and the influence of by-products formed during the processing of toxins can lead to organ damage. This causes disruptions in numerous processes in the body, and without treatment, can result in the patient’s death from liver failure.

According to statistics, the disease affects 0.002% of the population. Today, there is a noticeable trend of decreasing cases of toxic hepatitis due to the substitution of toxic substances in products with safe alternatives. Among people with alcohol and drug dependence, the risk of liver damage remains high.

Depending on the course, there are acute and chronic forms. In the acute form, symptoms manifest abruptly within 2-5 days after exposure to a toxin in a large dose.

Chronic toxic hepatitis develops slowly, and progression can last for years. The mild clinical picture deprives a person of reasons to consult a doctor until the disease reaches an advanced stage. This poses a serious problem in providing effective assistance to patients and restoring liver function.

Symptoms of Toxic Hepatitis

The signs of toxic hepatitis depend on the degree of poisoning and the type of toxic substance. In some cases, patients do not experience any changes in well-being, and liver damage is only detected upon diagnostic testing. For most patients, the clinical picture of the disease includes symptoms such as:

  • Bitter taste in the mouth
  • Fatigue
  • Loss of appetite
  • Belching
  • Abdominal bloating
  • Pain in the right side
  • Yellowing of the sclera, skin, and mucous membranes
  • Fever up to 38°C

Less commonly observed symptoms include skin rash and itching, darkening of urine and reduced daily volume, minor bleeding, and pale stools. In severe cases of toxic hepatitis, symptoms may include:

  • Bleeding from mucous membranes
  • Mental disturbances
  • Difficulty breathing

An important clinical sign of the disease is the elimination syndrome – when the toxin’s effects cease, signs of intoxication diminish, and the patient’s condition improves.

The clinical picture also depends on the type of substance affecting the liver:

  • Carbon tetrachloride: loss of consciousness and coma, difficulty breathing, gastrointestinal bleeding
  • Benzene: anemia, brain damage, cataracts
  • Arsenic: jaundice, kidney and peripheral nerve dysfunction
  • Phosphorus: increased bleeding, hypoglycemia
  • Copper: stomach pain, bleeding, acute kidney failure
  • Mushrooms: severe heart rhythm disturbances, seizures, acute liver necrosis, uremia, cirrhosis
  • Insecticides: multi-organ failure, central nervous system damage

Continuous exposure to toxic substances in small doses is also dangerous: poisoning will occur as toxins accumulate in fatty tissue, liver cells, and other organs. In the absence or inadequate treatment, toxic hepatitis in adults and children progresses to a chronic form, with fewer symptoms.

The main symptoms of chronic toxic hepatitis of the liver include:

  • Pain in the right side after eating
  • Weakness, drowsiness
  • Nausea and regular vomiting
  • Enlargement of the liver and spleen
  • Fatty liver degeneration

During remission, clinical signs of the disease may disappear, but during exacerbations, they reappear.

Causes of Toxic Hepatitis

Toxic liver damage resembling hepatitis occurs due to exposure to:

  • Industrial toxins: pesticides, arsenic, aldehydes, phenol
  • Plant alkaloids: strychnine, quinine, colchicine
  • Poisonous mushrooms
  • Ethyl alcohol
  • Medications: psychotropic drugs, antibiotics, cytostatics

The risk of encountering the disease is higher with:

  • Poor ecology
  • Stress
  • Unbalanced diet
  • Uncontrolled intake of medications
  • Alcohol abuse
  • Impaired bile excretion from the body

Often, the disease is associated with a profession that requires contact with chemical substances: in manufacturing, agriculture, and pest control in buildings.


Examination for suspected toxic hepatitis includes standard instrumental and laboratory methods used to detect liver diseases of any etiology. Diagnostic measures help assess the degree of activity of toxic hepatitis and the severity of damage to formulate an effective treatment plan.
After examination and medical history collection, the doctor will devise a diagnostic plan, which includes:

  • Biochemical blood analysis to determine bilirubin levels, alkaline phosphatase, ALT, and AST.
  • Coagulogram.
  • Complete blood and urine tests.
  • Investigations for viral, infectious, autoimmune, and radiation hepatitis.
  • Abdominal ultrasound.
  • Liver scintigraphy.
  • Magnetic resonance imaging.
  • Laparoscopic examination with liver tissue biopsy for histological examination.

Toxic hepatitis should be differentiated from liver damage of bacterial, viral, and parasitic etiology, gallstone disease, acute pancreatitis, oncology, autoimmune and reactive hepatitis, and developmental defects.
The main diagnostic criteria indicating the presence of toxic hepatitis in a patient are the association with the intake of hepatotoxic drugs, alcohol, and drugs, as well as household and industrial chemicals. It is also important to exclude other liver pathologies.

Treatment of Toxic Hepatitis

Treatment of toxic hepatitis is based on complete elimination of contact with the toxic substance to stop the progression of the pathology. Then the doctor will prescribe therapy aimed at stabilizing hepatocyte membranes, inhibiting fibrosis development (replacement of healthy tissue with connective tissue), stimulating regeneration, and cell repair.
For first aid and removal of toxins from the body, the following are indicated:

  • Gastric lavage.
  • Intake of sorbents.
  • Infusion and antidote therapy (intravenous drip).
  • Extracorporeal blood purification (plasmapheresis, hemosorption).

Recovery treatment after eliminating the symptoms of toxic hepatitis of the liver occurs in a hospital setting, where the patient receives cholagogue drugs, hepatoprotectors, symptomatic and supportive agents, as well as B-group vitamins, folic acid, nicotinic acid, and ascorbic acid.
After completing treatment for acute and chronic toxic hepatitis, it is important to reduce the liver’s workload by continuing to follow dietary recommendations: completely abstain from alcohol, fatty, and salty foods. The basis of the diet should consist of vegetables and dairy products, and meals should be small and scheduled.


The only way to prevent the development of toxic hepatitis is to avoid contact with any substances with hepatotoxic properties. When working with chemicals, all protective measures should be taken.
It is also important to refrain from alcohol consumption and any psychoactive substances without medical prescription. Any medications should be taken with caution. The danger also lies in herbal remedies, decoctions, and infusions of herbs: even plain water is toxic to humans in doses exceeding 6 liters.