Carbon tetrachloride is a halogenated alkane that is associated with significant hepatotoxicity. This may be potentiated in a person who abuses alcohol.
Carbon tetrachloride hepatotoxicity is associated with the generation of free radicals generated during its metabolism in the liver. CCl4 is activated to the trichloromethyl radical by cytochromes (CYP2E1, CYP2B1, CYP2B2, and possibly CYP3A).
Clinical features:
(1) A person has an exposure to carbon tetrachloride.
(2) The person abuses ethanol.
(3) The person develops a hepatocellular hepatotoxic reaction greater than expected from the exposure to carbon tetrachloride.
Other conditions potentiating the generation of free radicals (through induction of cytochrome P450) would be expected to increase the severity of hepatotoxicity. CYP450 inhibitors would be expected to reduce toxicity.
Following an exposure to carbon tetrachloride a person who gives a history of ethanol abuse should be monitored more closely for up to 2 weeks after the exposure.
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