Morning Report! Approach to Transaminitis in the 1000s

  • 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.

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