Iatrogenic toxic liver disease

Important factors for toxic injuries of the liver are route of application, binding rate to plasma proteins elimination rates, rates, biotransformation, enzyme induction, covalent binding to macromolecules and lipid peroxidation. The concurrence of these factors in the production of toxic liver injury is demonstrated in paracetamol-poisoning and isoniazid-hepatitis. In order to avoid misunderstanding and nomenclatory difficulties it is recommended to distinguish between obligatory and facultative hepatotoxins (or toxic hepatic reactions).