Page 186 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Masterclasses

M10.1 Traditional Chinese Medicine Induced Liver Toxicity 09:00 Convention Hall A

Liver Toxicity from Traditional Chinese Medication: A Diagnostic Challenge
Seto WK
Medicine Department, The University of Hong Kong, Hong Kong

Drug-related liver toxicity results in significant morbidity and mortality, and is a leading cause of acute liver failure worldwide.
While the risk of liver toxicity is well described for different medications in use in Hong Kong, the risk of liver derangement
from traditional Chinese medications (TCM) is less well-defined.

TCM-related liver derangement is common and comprises approximately 25% of acute hepatitis cases in Hong Kong. More
than 100 TCMs have been reported to be hepatotoxic in the medical literature, but large variations exist in the severity and
consistency of liver derangement. Nonetheless, TCM-related liver derangement remains a diagnostic challenge due to many
reasons. TCMs have many forms of prescription and are seldom prescribed individually. They can also be prescribed in tablet
or capsule form ( 中成藥 ), which sometimes combines multiple TCMs or even Western medications together. The production
quality of TCM could influence the degree of liver derangement. TCMs are most dangerous when taken in combination with
Western medications as the majority of such drug-drug interactions have not been described in medical literature.

The diagnosis of TCM-related liver derangement requires meticulous history taking. There could be extra-hepatic clinical
manifestations. While TCM-related liver derangement could be clinically silent, severe cases could result in acute liver
failure requiring liver transplantation. Serial measurements of liver biochemistry would indicate the severity and prognosis
of TCM-related derangement. Even after withdrawal of culprit TCM, normalisation of liver biochemistry could be prolonged,
sometimes taking weeks or months for recovery

M10.2 Traditional Chinese Medicine Induced Liver Toxicity 09:00 Convention Hall A

Wednesday, 4 May Laboratory Investigation of Traditional Chinese Medicine Related Poisonings
Mak T
Department of Pathology, Princess Margaret Hospital, Hong Kong

Before the Hospital Authority Toxicology Reference Laboratory came into service in 2004, there was not any laboratory
investigation on suspected Traditional Chinese Medicine (TCM) related poisonings in Hong Kong. The job was difficult. Most
clinicians, pathologists and scientists working in the orthodox healthcare system had minimal TCM-related training, if any at
all. The healthcare workers were unfamiliar with the terminology of TCM and had very limited knowledge of its pharmacology,
toxicology and science. In more than 10 years, a system has been developed to obtain all possible information to work on
TCM-related poisonings. Such information includes clinical manifestation of TCM-related poisonings, traditional laboratory
analyses, morphological identifications of herbs (including their remnants at times), interpretation of TCM composite formulae
and biochemical analyses of targeted TCM-related toxins in biological and non-biological specimens. Nouns in the above
sentence are in plural, which means we are dealing with multiple TCM-related poisonings. For some poisons (e.g. aconitum
alkaloids and tropane alkaloids), the system is pretty mature. However, for some other poisons, like hepatotoxic herbs, the
science is rudimentary. This presentation will share some successful and some not-so-successful attempts in establishing a
system to tackle TCM-related poisonings.

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