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Elevated transaminases are found in both rhabdomyolysis and delayed acetaminophen (APAP) toxicity. Establishing the cause of elevated transaminase can be difficult when there is unclear history of acetaminophen ingestion.
A retrospective study of patients with delayed acetaminophen toxicity or rhabdomyolysis from 2006 to 2011 was recently published.
The authors compared AST/ALT, CK/AST and CK/ALT ratio of
- 160 in the rhabdomyolysis group
- 68 in the acetaminophen overdose (all)
- 29 in the delayed acetaminophen overdose group
Results
AST/ALT ratio
- Rhabdomyolysis group: 1.66
- APAP overdose (all): 1.38
- Delayed APAP overdose: 1.3
CK/AST ratio
- Rhabdomyolysis group: 21.3
- APAP overdose (all): 5.49
- Delayed APAP overdose: 3.8
CK/ALT ratio
- Rhabdomyolysis group: 37.1
- APAP overdose (all): 5.77
- Delayed APAP overdose: 5.03
Conclusion
- Significantly higher ratio of AST/ALT, CK/AST and CK/ALT were found in rhabdomyolysis patients than delayed APAP overdose patients.
- These finding are based on small study population and need further validation/research before clinical application.