PT  - JOURNAL ARTICLE
AU  - Zita Galvin
AU  - Anna McDonough
AU  - John Ryan
AU  - Stephen Stewart
TI  - Blood alanine aminotransferase levels >1,000 IU/l – causes and outcomes
AID  - 10.7861/clinmedicine.15-3-244
DP  - 2015 Jun 01
TA  - Clinical Medicine
PG  - 244--247
VI  - 15
IP  - 3
4099  - http://www.rcpjournals.org/content/15/3/244.short
4100  - http://www.rcpjournals.org/content/15/3/244.full
SO  - Clin Med2015 Jun 01; 15
AB  - 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.