LFT in non-liver diseases

Q: In Rhabdomyolysis which of the aminotransferase tends to be higher than the other?

A) aspartate aminotransferase (AST) 

B) alanine aminotransferase (ALT) 

Answer: A

It is less appreciated that liver enzymes (LFT) are simultaneously elevated in rhabdomyolysis, and can easily be attributed to liver pathology. Elevations in LFT can be apparent even with Creatine Kinase (CK) at 1000 units/L. 

AST is usually elevated more than ALT. This clinical knowledge may help later in the course where the decline in AST (more than ALT) correlates with the resolution of rhabdomyolysis.

AST and ALT are widely found in skeletal and myocardial cells besides hepatic cells. Elevation can also be seen after hemolysis.

#lab-medicine

References:

1. Nathwani RA, Pais S, Reynolds TB, Kaplowitz N. Serum alanine aminotransferase in skeletal muscle diseases. Hepatology 2005; 41:380.

2. Yin LK, Tong KS. Elevated Alt and Ast in an Asymptomatic Person: What the primary care doctor should do?. Malays Fam Physician. 2009;4(2-3):98-99. Published 2009 Aug 31.

3. Malakouti M, Kataria A, Ali SK, Schenker S. Elevated Liver Enzymes in Asymptomatic Patients - What Should I Do?. J Clin Transl Hepatol. 2017;5(4):394-403. doi:10.14218/JCTH.2017.00027