{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T04:45:40Z","timestamp":1684298740022},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"5-6","license":[{"start":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T00:00:00Z","timestamp":1635206400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,16]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Drug-induced liver injury (DILI) is a significant cause of morbidity and mortality. Establishing a diagnosis is challenging due to the broad differential diagnosis of liver injury. We retrospectively reviewed patients with severe idiosyncratic DILI at Walter Reed National Military Medical Center in order to define the scope and patterns of injury in the military population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using the military health database, we identified a total of 110 patients who had an International Classification of Disease (ICD)-10 code for toxic liver injury in the electronic medical record at Walter Reed National Military Medical Center between 2016 and 2019. Each patient record was reviewed, and all pertinent data for included patients were recorded into a database for analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Twenty-seven out of 110 patients with a diagnostic code for toxic liver injury met inclusion criteria for severe idiosyncratic DILI. Nine cases were caused by supplements, including 5 active duty service members using synthetic anabolic steroids or preworkout supplements. The majority of patients were men and one-third were serving on active duty. The ranges of liver enzyme elevation and patterns of liver injury widely varied.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Military service members are at particularly high risk for DILI given the frequent use of over-the-counter and other unregulated strength- and performance-enhancing supplements. These injuries not only have significant medical consequences but can profoundly impact military readiness and mission capability. Diagnosis of DILI among active duty service members requires a strong index of suspicion, and inquiry regarding all ingestions is crucial. Educating physicians, providers, and policy makers on the risks of supplement-induced liver injury among service members is crucial. These data will facilitate additional studies exploring susceptibility to severe idiosyncratic DILI among the military population.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usab445","type":"journal-article","created":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T05:04:05Z","timestamp":1635224645000},"page":"e991-e996","source":"Crossref","is-referenced-by-count":0,"title":["Severe Drug-Induced Liver Injury in the Military: A Retrospective Review"],"prefix":"10.1093","volume":"188","author":[{"given":"Sarah","family":"Ordway","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Gastroenterology\/Hepatology, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brett","family":"Sadowski","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Gastroenterology\/Hepatology, Portsmouth Naval Medical Center , Portsmouth, VA 23708, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn E","family":"Driggers","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Kwok","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Division of Gastroenterology\/Hepatology, Fort Belvoir Community Hospital , Fort Belvoir, VA 22060, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,10,26]]},"reference":[{"issue":"5","key":"2023051613481688900_R1","doi-asserted-by":"crossref","first-page":"878","DOI":"10.14309\/ajg.0000000000001259","article-title":"ACG clinical guideline: diagnosis and management of idiosyncratic drug-induced liver injury","volume":"116","author":"Chalasani","year":"2021","journal-title":"Am J Gastroenterol"},{"issue":"7","key":"2023051613481688900_R2","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1053\/j.gastro.2015.03.006","article-title":"Features and outcomes of 899 patients with drug-induced liver injury: the DILIN prospective study","volume":"148","author":"Chalasani","year":"2015","journal-title":"Gastroenterology"},{"issue":"9","key":"2023051613481688900_R3","doi-asserted-by":"crossref","first-page":"e1169","DOI":"10.7205\/MILMED-D-15-00502","article-title":"Mission compromised? Drug-induced liver injury from prohormone supplements containing anabolic\u2013androgenic steroids in two deployed U.S. service members","volume":"181","author":"Magee","year":"2016","journal-title":"Mil Med"},{"issue":"10","key":"2023051613481688900_R4","doi-asserted-by":"crossref","first-page":"e1168","DOI":"10.7205\/MILMED-D-13-00228","article-title":"Cholestatic liver injury associated with dietary supplements: a report of five cases in active duty service members","volume":"178","author":"Peterson","year":"2013","journal-title":"Mil Med"},{"issue":"1","key":"2023051613481688900_R5","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1002\/hep.28813","article-title":"Liver injury from herbal and dietary supplements","volume":"65","author":"Navarro","year":"2016","journal-title":"Hepatology"},{"issue":"9","key":"2023051613481688900_R6","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1111\/apt.15211","article-title":"Severe and protracted cholestasis in 44 young men taking bodybuilding supplements: assessment of genetic, clinical and chemical risk factors","volume":"49","author":"Stolz","year":"2019","journal-title":"Aliment Pharmacol Ther"},{"issue":"7","key":"2023051613481688900_R7","doi-asserted-by":"crossref","first-page":"503","DOI":"10.7326\/0003-4819-159-7-201310010-00019","article-title":"Hepatotoxicity associated with the dietary supplement NO-XPLODE","volume":"159","author":"Martin","year":"2013","journal-title":"Ann Intern Med"},{"issue":"4","key":"2023051613481688900_R8","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1002\/hep.28967","article-title":"Clinical presentations and outcomes of bile duct loss caused by drugs and herbal and dietary supplements","volume":"65","author":"Bonkovsky","year":"2017","journal-title":"Hepatology"},{"issue":"1","key":"2023051613481688900_R9","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.cld.2016.08.004","article-title":"Epidemiology and genetic risk factors of drug hepatotoxicity","volume":"21","author":"Ahmad","year":"2017","journal-title":"Clin Liver Dis"},{"key":"2023051613481688900_R10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/jn\/nxab239.","article-title":"Prevalence of and factors associated with dietary supplement use in a stratified, random sample of US military personnel: the US military dietary supplement use study","author":"Knapik","year":"2021","journal-title":"J Nutr"},{"key":"2023051613481688900_R11","article-title":"Dietary supplement use among adults: United States, 2017\u20132018","volume-title":"NCHS Data Brief, no 399","author":"Mishra","year":"2021"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/188\/5-6\/e991\/50342363\/usab445.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/188\/5-6\/e991\/50342363\/usab445.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T13:51:39Z","timestamp":1684245099000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/188\/5-6\/e991\/6410153"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,26]]},"references-count":11,"journal-issue":{"issue":"5-6","published-online":{"date-parts":[[2021,10,26]]},"published-print":{"date-parts":[[2023,5,16]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usab445","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,5,1]]},"published":{"date-parts":[[2021,10,26]]}}}