title: Blood alanine aminotransferase levels >1,000 IU/l - causes and outcomes.
abstract: Standard medical education dictates that the vast majority of cases of an alanine aminotransferase (ALT) level >1,000 IU/l will be due to acute ischaemia, acute drug-induced liver injury (DILI) (usually paracetamol) or acute viral hepatitis. There are very few references in the literature to other potential causes of an ALT >1,000 IU/l nor to the prognosis ascribed to each aetiology. In this study, we have confirmed that the main causes of a dramatic ALT rise are ischaemic liver injury, DILI and viral hepatitis. Common bile duct stones and hepatitis E are two causes for which there needs to be a high index of suspicion as the necessary tests may not be in the clinician's first-line investigation panel. Failing to find a cause and determining that the cause was ischaemic both have poor prognostic implications.
authors.affiliation: Centre for Liver Diseases, Mater Misericordiae University Hospital, Dublin, Ireland zitagalvin@gmail.com.
authors.forename: Zita
authors.initials: Z
authors.lastname: Galvin
authors.affiliation: Centre for Liver Diseases, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: Anna
authors.initials: A
authors.lastname: McDonough
authors.affiliation: Centre for Liver Diseases, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Ryan
authors.affiliation: Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: Stephen
authors.initials: S
authors.lastname: Stewart
mesh_terms: D000410:Alanine Transaminase / Q000097:blood*; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000097:blood / Q000175:diagnosis / Q000201:enzymology*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D000410:Alanine Transaminase
keywords: Alanine aminotransferase; acute hepatitis; aetiology; prognosis; transaminases