Title: Can transaminase and CK ratio help differentiate rhabdomyolysis vs. delayed acetaminophen overdose?<br/>Author: Hong Kim<br/><a href='http://umem.org/profiles/faculty/526/'>[Click to email author]</a><hr/><p>
        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.</p>
<p>
        A retrospective study of patients with delayed acetaminophen toxicity or rhabdomyolysis from 2006 to 2011 was recently published.</p>
<p>
        The authors compared AST/ALT, CK/AST and CK/ALT ratio of </p>
<ul>
        <li>
                160 in the rhabdomyolysis group</li>
        <li>
                68 in the acetaminophen overdose (all)</li>
        <li>
                29 in the delayed acetaminophen overdose group</li>
</ul>
<p>
        <strong>Results</strong></p>
<p>
        AST/ALT ratio</p>
<ul>
        <li>
                Rhabdomyolysis group: 1.66</li>
        <li>
                APAP overdose (all): 1.38</li>
        <li>
                Delayed APAP overdose: 1.3</li>
</ul>
<p>
        CK/AST ratio</p>
<ul>
        <li>
                Rhabdomyolysis group: 21.3</li>
        <li>
                APAP overdose (all): 5.49</li>
        <li>
                Delayed APAP overdose: 3.8</li>
</ul>
<p>
        CK/ALT ratio</p>
<ul>
        <li>
                Rhabdomyolysis group: 37.1</li>
        <li>
                APAP overdose (all): 5.77</li>
        <li>
                Delayed APAP overdose: 5.03</li>
</ul>
<p>
        <strong>Conclusion</strong></p>
<ul>
        <li>
                Significantly higher ratio of AST/ALT, CK/AST and CK/ALT were found in rhabdomyolysis patients than delayed APAP overdose patients.</li>
        <li>
                These finding are based on small study population and need further validation/research before clinical application.</li>
</ul>