Alcohol

Hepatotoxic substances

– Drugs: Antibiotics (tetracycline, bleomycin, puromycin), cytotoxic agents (methotrexate, asparaginase), vitamins (high-dose vitamin A), other drugs (amiodarone, estrogens, glucocorticoids, hydralazine, salicylates, sodium valproate, warfarin)

– Chemicals: Chlorinated hydrocarbons, tetrachloromethane, carbon disulfide, phosphate, barium salts

– Mushroom toxins (alpha-amanitin)

Metabolic conditions and nutritional factors

– Overweight, obesity, starvation, protein malnutrition (kwashiorkor)

– Diabetes mellitus

– Cushing syndrome

– Zinc deficiency

– Parenteral nutrition that is long-term or total (or both; choline and carnitine deficiency)

– Hyperlipidemia

Malabsorption syndromes

– Diseases of pancreas

– Intestinal resection

– Intestinal anastomoses (eg, jejunoileal anastomosis)

– Celiac disease

– Inflammatory bowel disease (ulcerative colitis, Crohn disease)

Inherited metabolic disorders

– Abetalipoproteinemia

– Storage diseases involving cholesterol esters (Wolman disease), sphingomyelin (Niemann-Pick disease), gangliosides (Tay-Sachs disease), glucocerebroside (Gaucher disease), copper (Wilson disease), iron (hemochromatosis), glycogen (glycogenoses), galactose, fructose, tyrosine, homocysteine, phytate (Refsum disease)

 – Inherited urea cycle abnormalities

Infectious diseases

– Viral hepatitis C

– Fulminant viral hepatitis D

– Effects of endotoxins

Other

– Reye syndrome

– Complications of pregnancy: Acute hepatic steatosis in pregnancy, eclampsia, HELLP syndrome (hemolysis, elevated liver enzyme [aminotransferase] levels, low platelet levels [thrombocytopenia])