Drug induced liver injury laboratory findings: Difference between revisions
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* [[AST]] / [[serum glutamic oxaloacetic transaminase]] ([[SGOT]]): will be elevated ≥ 3 times the upper limit of normal in hepatocellular injury cases, and even > 20 times the upper limit of normal in acute hepatocellular injury | * [[AST]] / [[serum glutamic oxaloacetic transaminase]] ([[SGOT]]): will be elevated ≥ 3 times the upper limit of normal in hepatocellular injury cases, and even > 20 times the upper limit of normal in acute hepatocellular injury | ||
* [[ALT]] / [[serum glutamic pyruvate transaminase]] ([[SGPT]]): will be elevated ≥ 3 times the upper limit of normal in hepatocellular injury cases, and even > 20 times the upper limit of normal in acute hepatocellular injury | * [[ALT]] / [[serum glutamic pyruvate transaminase]] ([[SGPT]]): will be elevated ≥ 3 times the upper limit of normal in hepatocellular injury cases, and even > 20 times the upper limit of normal in acute hepatocellular injury | ||
* [[Albumin]]: will be low in chronic liver injury | * [[Albumin]]: will be low in chronic liver injury or cases of severe acute liver injury leading to abnormal synthetic function | ||
* [[Bilirubin]]: may be elevated in both hepatocellular and cholestatic injury | * [[Bilirubin]]: may be elevated in both hepatocellular and cholestatic injury | ||
* [[Prothrombin time]], | * [[Prothrombin time]], may be elevated due to coagulopathy from either hepatocellular or cholestatic injury | ||
* [[Urinalysis]] to assess bilirubinuria | * [[Urinalysis]] to assess bilirubinuria | ||
* Drug levels, e.g. acetaminophen serum level | * Drug levels, e.g. acetaminophen serum level | ||
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The following tests are also helpful in patients presenting with autoimmune-like features: | The following tests are also helpful in patients presenting with autoimmune-like features: | ||
* [[Antinuclear antibody]] | * [[Antinuclear antibody]] | ||
* [[Anti-mitochondrial antibody]] ([[AMA]]) to distinguish from [[ | * [[Anti-mitochondrial antibody]] ([[AMA]]) to distinguish from [[primary biliary cirrhosis]] | ||
* [[Anti smooth muscle antibody]] ([[ASMA]]) to distinguish from [[autoimmune hepatitis]] | * [[Anti smooth muscle antibody]] ([[ASMA]]) to distinguish from [[autoimmune hepatitis]] | ||
Revision as of 20:58, 19 October 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rachita Navara, M.D. [2]
Overview
Laboratory tests help assess the severity of illness as well as help distinguish drug induced liver injury from other pathologies (see also: Differential Diagnosis). Patterns of abnormalities can also distinguish between hepatocellular and cholestatic liver injury (see also: Classification).
Laboratory Findings
The following laboratory tests should be obtained in all cases of suspected drug induced liver injury:
- CBC with differential: may reveal eosinophilia in hypersensitivity reactions e.g. DRESS, or lymphocytosis (with atypical lymphocytes on smear) in mononucleosis-like illnesses
- Alkaline phosphatase: will be disproportionately elevated (≥ 2 times the upper limit of normal) compared to aminotransferases in cholestatic injury
- AST / serum glutamic oxaloacetic transaminase (SGOT): will be elevated ≥ 3 times the upper limit of normal in hepatocellular injury cases, and even > 20 times the upper limit of normal in acute hepatocellular injury
- ALT / serum glutamic pyruvate transaminase (SGPT): will be elevated ≥ 3 times the upper limit of normal in hepatocellular injury cases, and even > 20 times the upper limit of normal in acute hepatocellular injury
- Albumin: will be low in chronic liver injury or cases of severe acute liver injury leading to abnormal synthetic function
- Bilirubin: may be elevated in both hepatocellular and cholestatic injury
- Prothrombin time, may be elevated due to coagulopathy from either hepatocellular or cholestatic injury
- Urinalysis to assess bilirubinuria
- Drug levels, e.g. acetaminophen serum level
The following tests are also helpful in patients presenting with autoimmune-like features:
- Antinuclear antibody
- Anti-mitochondrial antibody (AMA) to distinguish from primary biliary cirrhosis
- Anti smooth muscle antibody (ASMA) to distinguish from autoimmune hepatitis