An Approach to Drug-Induced Liver Injury from the Geriatric Perspective.
PURPOSE OF REVIEW
With its high variability in both presentation and severity, drug-induced liver injury (DILI) is a complex condition increasingly confronting all providers. DILI has an even more muddled presentation among the geriatric population due to age-related changes in liver physiology and biochemistry as well as polypharmacy common in the geriatric population.


RECENT FINDINGS
Most cases of DILI are idiosyncratic and unpredictable. DILI, especially related to herbal and dietary supplement (HDS) use, is increasingly recognized as a leading cause of acute liver failure and need for liver transplantation. Unfortunately, liver transplantation is a limited option for the elderly, a population that exhibits significant HDS use. One recent study suggests that early use of N-acetylcysteine may be useful in preventing progression to acute liver failure in non-acetaminophen DILI. In the future, a personalized medicine approach using genomic signatures may be feasible to prevent DILI. This review serves to raise recognition of the unique aspects of DILI in the geriatric population to promote rapid diagnosis and early intervention to prevent progression to liver failure and death. For now, DILI remains a diagnosis of exclusion, and care providers for the elderly must focus on obtaining a thorough history that includes HDS use and intervening early in suspected DILI cases.
['Lee|Brian T|BT|', 'Odin|Joseph A|JA|http://orcid.org/0000-0003-0923-5685', 'Grewal|Priya|P|']
D000367:Age Factors D000368:Aged D000375:Aging D056486:Chemical and Drug Induced Liver Injury D006801:Humans D008099:Liver D019338:Polypharmacy D012307:Risk Factors
Drug-induced liver injury Geriatric Polypharmacy Herbal and dietary supplement use Immunotherapy in elderly