Chemical hepatic injury may result from accidental or suicidal exposure to toxic agents in the home or at work or from adverse reactions to medicinal agents. Chemical hepatic injury can lead to acute or chronic syndromes. Acute injury may be cytotoxic, cholestatic, or mixed. Cytotoxic injury is characterized by necrosis, steatosis, or both. Cholestatic injury is characterized by arrested bile flow and may be associated with portal inflammation or may occur in a setting in which there is no evidence of inflammation. Chronic hepatic injury includes chronic active hepatitis, steatosis, phospholipidosis, veno-occlusive disease, several forms of cirrhosis, peliosis hepatis, and hepatic neoplasms. The mechanism for injury may be intrinsic toxicity of the agent, reaction of an unusually susceptible host, or a combination of the two factors. Unusual susceptibility may be the result of immunologic idiosyncrasy (hypersensitivity reaction) or injury from a toxic metabolite (metabolic idiosyncrasy) of the drug.