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Abnormal liver function tests associated with severe rhabdomyolysis
1Department of General Medicine, Monash Health, Clayton VIC 3168, Australia.
World Journal of Gastroenterology
|March 25, 2020
Summary
Severe skeletal muscle injury, or rhabdomyolysis, can elevate liver enzymes. This review explores why elevated aminotransferases occur with muscle damage and how to avoid unnecessary liver investigations.
Area of Science:
- Biochemistry
- Clinical Medicine
- Pathophysiology
Background:
- Rhabdomyolysis involves skeletal muscle breakdown, releasing intracellular components into circulation.
- Elevated serum aminotransferases (AST, ALT) are common in severe rhabdomyolysis, mimicking liver injury.
- This diagnostic challenge can lead to extensive liver investigations, including liver biopsy.
Purpose of the Study:
- To review the association between muscle injury and elevated aminotransferases.
- To discuss the diagnostic dilemma posed by abnormal liver function tests in rhabdomyolysis.
- To explore mechanisms and potential diagnostic improvements.
Main Methods:
- Literature review of clinical and experimental evidence.
- Discussion of pathophysiological mechanisms linking muscle injury to aminotransferase elevation.
- Exploration of diagnostic strategies.
Main Results:
- Serum aminotransferases lack tissue specificity, making differentiation between liver and muscle injury difficult.
- Oxidative stress and other mechanisms may contribute to actual liver injury in rhabdomyolysis.
- Muscle itself is a significant source of elevated aminotransferases.
Conclusions:
- Elevated aminotransferases in rhabdomyolysis often originate from muscle, not primary liver damage.
- Distinguishing muscle-derived from liver-derived aminotransferases is crucial to avoid unnecessary liver investigations.
- Improved diagnostic tools are needed to accurately assess liver function in patients with rhabdomyolysis.
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