TABLE 2.

Pathologic and Biochemical Changes in Environmental Toxin–Induced Injury

InjuryBiochemical Response*Example of CauseSusceptible Age Group
AST-ALTALP
Acute syndromes
 Hepatocellular
  Necrosis8–500×<3×Ecstasy, CCl4Adol
  Steatosis8–20×<3×CCl4Adol
 Cholestasis<8×>3×Anabolic steroidsAdol
 Mixed>8×>3×Amanita intoxicationAll
Chronic syndromes
 Hepatocellular
  Necrosis3–50×1–3×Herbal products (eg, Chaparral)Infants
  CirrhosisArsenic, CCl4Adol (OE?)
 Cholestasis1–5×3–20×Methylene dianilineAdol (OE?)
 Vascular lesions
  Peliosis hepatis<3×<3×Vinyl chlorideAdol?
  VOD1–3×Pyrrolizidine alkaloidsInfants
  Portal HTN1–3×Vinyl chloride, arsenicAll
Hypervitaminosis AAdol
 Liver tumors
  AdenomaAnabolic steroidsAdol
  HCCAFB, arsenicAll?
  HemangiosarcomaVinyl chlorideAll?
  • Modified from Zimmerman.19

    HTN indicates hypertension; HCC, hepatocellular carcinoma; AST, aspartate aminotransferase; V×, variable; CCl4, carbon tetrachloride; Adol, adolescents; OE, occupational exposure.

  • * Expressed as times (×) upper limit of normal.