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Non-paracetamol drug-induced fulminant hepatic failure among adults in Scotland

Background and methods This study details 30 cases of non-paracetamol drug-induced fulminant hepatic failure (NPDI-FHF) that have presented to the Scottish Liver Transplant Unit since 1992. Using the patients' case notes and a previously constructed database, the demographics of NPDI-FHF in Scotland were studied. The clinical and biochemical features, and the outcome of each individual case were also investigated. Results Of the 30 patients, 10 died. Our study revealed that antibiotics are the most commonly associated drugs with NPDI-FHF while ecstasy and anti-tuberculous drugs are also commonly implicated. The geographical distribution of referrals mirrors that of the population distribution and NPDI-FHF is not confined to any particular social class. It is, more than twice as common among females than males, however. The incidence is evenly spread across the different age categories, but NPDI-FHF as a consequence of ecstasy ingestion is confined to younger age groups. Ecstasy associated NPDI-FHF was also associated with short latency periods. Conclusion NPDI-FHF is not a common problem in Scotland, but it is a serious problem for those affected and consumes considerable health care resources. Doctors need to be made aware that commonly prescribed drugs may cause fulminant hepatic failure. When a young adult presents with fulminant hepatic failure of sudden onset, ecstasy consumption must be considered.