- First rule out fulminant liver failure. Fulminant Liver Failure: no history of liver disease, transaminitis, coagulopathy, and encephalopathy.
- For patients with AST/ALT in the thousands, think: Viral, ischemic, toxins, or autoimmune etiologies
- Hemoarthroses: think of hemophilia (Factor 8/9 deficiency), platelet dysfunction more likely to cause petechiae.
- Alcoholic liver disease normally presents with AST and ALT in the 300-400s. AST/ALT ratio >1
- Hep A and B more likely to cause transaminitis in the 1000s. Unlikely to be seen in acute HCV infection, hemochromatosis, alcoholic liver disease.
- Check HAV IgM for acute hep A infection. Transmitted via fecal oral route. More likely to cause significant transaminitis in adults vs children.
The Chief Residents' Blog