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Milan Mohammad1,2, Zakaria Alaoui-Ismaili1, Michael Dan Arvig2,3

  • 1Biomedicinsk Institut, Københavns Universitet.

Ugeskrift for Laeger
|March 10, 2023
PubMed
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Intense exercise can cause rhabdomyolysis, leading to elevated liver enzymes like AST and ALT. These enzyme elevations often indicate muscle damage, not liver injury, preventing unnecessary tests.

Area of Science:

  • Sports Medicine
  • Biochemistry
  • Clinical Pathology

Background:

  • Rhabdomyolysis is a condition involving skeletal muscle breakdown.
  • Elevated liver enzymes, aspartate transaminase (AST) and alanine transaminase (ALT), can be observed in rhabdomyolysis.
  • Distinguishing muscle-derived enzyme elevation from true liver damage is crucial for accurate diagnosis and treatment.

Observation:

  • A case report details rhabdomyolysis following strenuous physical activity.
  • Initial laboratory tests revealed significantly elevated creatine kinase, consistent with muscle damage.
  • Aspartate transaminase (AST) and alanine transaminase (ALT) levels were also markedly increased, initially suggesting liver injury.

Findings:

  • The elevated AST and ALT levels were primarily attributed to skeletal muscle damage, a common finding in rhabdomyolysis.

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  • Specific liver function markers, including international normalised ratio (INR) and ϒ-glutamyl transferase (GGT), remained within normal limits.
  • This pattern indicates that AST and ALT elevations in this context are more indicative of muscle breakdown than hepatocellular damage.
  • Implications:

    • Understanding the source of elevated AST and ALT in rhabdomyolysis is critical for avoiding misdiagnosis of liver disease.
    • This knowledge can guide clinicians to avoid unnecessary diagnostic procedures and liver-specific treatments.
    • Accurate interpretation of liver enzymes in the setting of muscle injury can lead to more efficient patient management.