title: Significance of alanine aminotransferase levels in patients admitted for cocaine intoxication.
abstract: BACKGROUND
  Experimental studies in animal models and case reports in humans have described the hepatotoxic potential of cocaine. However, there are few data regarding the clinical and laboratory characteristics of patients admitted for cocaine intoxication, particularly regarding the status of the liver enzymes.
  
  
  OBJECTIVE
  To investigate the significance of alanine aminotransferase (ALT) levels in individuals hospitalized for acute cocaine intoxication.
  
  
  METHODS
  Retrospective study with standardized chart review that included patients admitted between January 2003 and December 2010. Bivariate analyses were used to investigate factors associated with ALT above the upper tertile according to gender. Cases of marked ALT elevation were described in detail.
  
  
  RESULTS
  Ninety-three patients were included (79% men, mean age of 27.73±9.97 y). ALT above the upper tertile was associated with higher aspartate aminotransferase (AST), creatine phosphokinase, creatinine, and international normalized ratio. Higher levels of ALT were also related to acute renal failure and death. Five subjects had severe ALT elevation during follow-up and all had evidence of hepatocellular dysfunction (jaundice, prolonged prothrombin time with or without hepatic encephalopathy), rhabdomyolysis, and acute renal failure. AST/ALT ratio <2 was present in 2 subjects with severe ALT elevation at admission, but AST/ALT ratio >2 was observed in 3 cases with evidence of progression to acute liver injury.
  
  
  CONCLUSIONS
  In acute cocaine intoxication, higher ALT levels were associated with evidence of muscle damage, progression to acute renal failure, and death. Severe liver damage was observed in 5% of the sample and was associated with rhabdomyolysis and renal failure in all cases.
authors: *Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis †Center for Toxicological Information of Santa Catarina (CIT/SC), SC, Brazil.
authors: Fernanda
authors: F
authors: Guollo
authors: Janaína L
authors: JL
authors: Narciso-Schiavon
authors: Adriana M
authors: AM
authors: Barotto
authors: Marlene
authors: M
authors: Zannin
authors: Leonardo L
authors: LL
authors: Schiavon
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D000697:Central Nervous System Stimulants / Q000506:poisoning*; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D004796:Clinical Enzyme Tests; D003042:Cocaine / Q000506:poisoning*; D019970:Cocaine-Related Disorders / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D010343:Patient Admission; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000139:chemically induced; D012307:Risk Factors; D015854:Up-Regulation; D055815:Young Adult
chemical_list: D015415:Biomarkers; D000697:Central Nervous System Stimulants; D000410:Alanine Transaminase; D003042:Cocaine