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.
