Time sensitive managements in hepato-gastroenterology

Table 1 Time-sensitive interventions focusing on drug-induced liver injury

Drug/class	Mechanism	Time sensitivity	Key intervention
Acetaminophen	Direct toxin (NAPQI)	< 8-12 hours for NAC efficacy	NAC, early levels, transplant if needed
Isoniazid	Hepatocellular (immune)	Days-weeks; need early stop	Monitor LFTs, stop the drug promptly
Halothane	Immune hepatitis	Re-exposure fatal	Avoid re-exposure, early stop
Amiodarone (IV)	Direct toxic	Hours-days	Discontinue if ALT/AST rise
Valproic acid	Mitochondrial dysfunction	Hours-days	Stop the drug, consider L-carnitine
Methotrexate (acute)	Overdose, accumulation	Hours (folinic acid critical)	Leucovorin rescue
DRESS-related drugs	Immune-mediated	Days; worsening if delayed stop	Stop all suspect drugs urgently
Herbal toxins	Idiosyncratic or direct	Hours-days	Stop supplement, list in history

NAPQI: N-acetyl-p-benzoquinone imine; NAC: N-acetylcysteine; LFT: Liver function test; IV: Intravenous; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase.