<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1409-0015</journal-id>
<journal-title><![CDATA[Medicina Legal de Costa Rica]]></journal-title>
<abbrev-journal-title><![CDATA[Med. leg. Costa Rica]]></abbrev-journal-title>
<issn>1409-0015</issn>
<publisher>
<publisher-name><![CDATA[Asociación Costarricense de Medicina Forense]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1409-00152016000100085</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Hepatotoxicidad por sustancias de origen botánico]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Álvarez Umaña]]></surname>
<given-names><![CDATA[Silvia Vanessa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Soto Cerdas]]></surname>
<given-names><![CDATA[Jahaira Vanessa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Quirós Quirós]]></surname>
<given-names><![CDATA[Víctor Daniel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González Sáenz]]></surname>
<given-names><![CDATA[Marcela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,dra.silvia-alvarez@hotmail.com  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af2">
<institution><![CDATA[,aff2  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af3">
<institution><![CDATA[,aff3  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af4">
<institution><![CDATA[,aff4  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>03</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>03</month>
<year>2016</year>
</pub-date>
<volume>33</volume>
<numero>1</numero>
<fpage>85</fpage>
<lpage>95</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_arttext&amp;pid=S1409-00152016000100085&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_abstract&amp;pid=S1409-00152016000100085&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_pdf&amp;pid=S1409-00152016000100085&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen: Existe un interés creciente en prevenir la enfermedad y mejorar la salud, por lo que se han desarrollado suplementos nutricionales percibidos por la población como inofensivos, sin embargo, las plantas son productoras de sustancias químicas que pueden inducir a daño hepático. Los suplementos usados para fisicoculturismo y reducción de peso son los productos naturales que más han reportado hepatotoxicidad en los últimos tiempos. El diagnóstico de la lesión hepática asociado a productos naturales debe hacerse de forma sistematizada y debe incluir información sobre el inicio del consumo del producto natural, el periodo de tratamiento y el periodo de latencia. Comúnmente, el cuadro clínico es agudo y los síntomas en su mayoría son inespecíficos. Se han definido criterios de hepatotoxicidad a través de la medición de los niveles de la alanina aminotransferasa (ALT) y la fosfatasa alcalina (FA) y la relación entre estas dos variables. Con la cesación del agente implicado, los signos clínicos generalmente ceden y se da una marcada disminución de los niveles de las enzimas hepáticas. La positividad de la reexposición no intencionada del producto es el gold standard para confirmar la hepatotoxicidad por sustancias naturales. No existen hallazgos histológicos específicos de lesión hepática, por lo que la biopsia no forma parte de los algoritmos para diagnósitico. Con el fin de objetivizar la valoración de efectos adversos se utiliza la escala de CIOMS/RUCAM (Council for International Organizations of Medical Sciences/Roussel Uclaf Causality Assesment Method) que permite determinar la probabilidad de lesión hepática secundaria al producto. Además de la hepatotoxicidad directa producida por sustancias de origen botánico, se han descrito interacciones entre medicamentos convencionales y los productos herbales, por lo que el médico tratante debe indagar sobre el uso de estos productos. No existe antídoto para el tratamiento de la hepatotoxicidad por hierbas o productos nutricionales de origen botánico, por lo que la suspención de la noxa es el único factor terapéutico para el manejo de estos pacientes.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract: here is a growing interest in prevention of diseases and improvement of health. That is why nutritional supplements have been developed and perceived by people as harmless, but plants produce chemical substances that can lead to liver damage. The supplements used for bodybuilding and weight reduction constituted the most common natural products accounting for hepatotoxicity in last times. The diagnosis of liver injury associated to natural products should be done in a systematic way and should include information about the first use of the substance, the treatment period and latency. Commonly, the clinic is an acute condition with nonspecific symptoms. The measurement of levels of alanine aminotransferase (ALT), alkaline phosphatase (PA) and relationship between these variables serve as criteria of liver injury. With cessation of the agent involved, clinical signs usually yield and there is a marked decrease in the liver biomarkers levels. Positive results for no intentional reexposure is the gold standard to confirm hepatotoxicity to natural substances. There are no specific histologic findings for liver damage, so biopsy cannot be used for diagnosis. In order to objectify the adverse effects we use the CIOMS/RUCAM Scale (Council for International Organizations of Medical Sciences/ Roussel Uclaf Causality Assesment Method). In addition to the potential for direct hepatotoxicity, some of the herbs may have interactions with certain prescription medications, so physicians should ask for using natural products and prevention of concomitant use. There is no antidote for the treatment of hepatotoxicity for herbs, so the suspension of using these products is the only therapeutic management.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[hepatotoxicidad]]></kwd>
<kwd lng="es"><![CDATA[lesión hepática, suplementos nutricionales]]></kwd>
<kwd lng="es"><![CDATA[productos naturales]]></kwd>
<kwd lng="es"><![CDATA[sustancias naturales]]></kwd>
<kwd lng="es"><![CDATA[origen botánico]]></kwd>
<kwd lng="en"><![CDATA[hepatotoxicity]]></kwd>
<kwd lng="en"><![CDATA[hepatic injury]]></kwd>
<kwd lng="en"><![CDATA[nutritional supplements]]></kwd>
<kwd lng="en"><![CDATA[natural products]]></kwd>
<kwd lng="en"><![CDATA[natural sustances]]></kwd>
<kwd lng="en"><![CDATA[botanical origin]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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