Product | Other names/toxins | Clinical manifestations | Pathologic findings |
Chaparral leaf | Laurie tridentata | ALT 10 to 20x normal; AST 7 to 10x normal; elevated bilirubin and prothrombin time; reversible; dose dependent | Acute and chronic liver injury: portal inflammation with bile duct proliferation; lobular necrosis and collapse |
"Creosote bush" |
"Grease wood" |
Nordi-hydroguaiaretic acid (HDGA) |
Jin Bu Huan | Lycopodium serratum | ALT/AST 10 to 20x normal; elevated bilirubin and prothrombin time; reversible | Acute and chronic liver injury: focal hepatic necrosis; eosinophilia; steatosis; bridging fibrosis and necrosis |
Levo-tetrahydropalmatine |
Germander | Teucrium chamaedrys | ALT/AST 5 to 10x normal; elevated bilirubin; reversible | Acute and chronic liver injury: hepatocellular necrosis; portal inflammation; fibrosis |
Teucrium polium |
Kava | Piper methysticum rhizoma | ALT/AST 10 to 20X normal; elevated bilirubin, prothrombin time; can be fatal | Hepatic necrosis; cholestasis, lobular hepatitis |
Mistletoe | Viscum album | ALT/AST 5 to 10x normal; elevated bilirubin; reversible | Acute and chronic hepatitis: hepatocellular injury |
Skullcap | Scutellaria spp | ALT/AST 5 to 10x normal; elevated bilirubin; reversible | Acute hepatitis; hepatocellular injury |
Toxic alkaloids | Symphytum (Comfrey) | ALT/AST 3 to 10x normal; elevated bilirubin; generally reversible; can be fatal; dose dependent | Hepatic venoocclusive disease; acute inflammation |
Senecio spp |
Crotalaria spp |
Heliotropium spp |
Maté (Paraquay) tea |
Ackee Fruit |
Atractylis gummifera |
Callilepsis laureola |
Cassia angustifolia (Senna) |
Cocaine (Erythroxylon coca) |
Sassafras albidum |
Borago officinalis |
Pennyroyal | Squawmint oil | ALT/AST 10 to 20x normal; associated with renal failure | Acute liver injury related to depletion of hepatic glutathione |
Hedeoma pulegoides |
Mentha pulegium |
Toxic terpenes, especially isopropylidene |