Three things came across my mind:
1. Plasma ALT t1/2 is 4-5x higher than the plasma AST t1/2 (AST/ALT ratio
depends on the time period between sampling and the incident)
2. Malignant hyperthermia induced by (numerous) drugs taken (neuroleptics
are known inducers of this disease; ARF is consistent with this
possibility; I would expect AST > ALT in this condition, but t1/2 argument
remains)
3. Carbamazepine increases both AST and ALT activities (however I do not
know which enzyme should have higher value if this is the case).
All these facts could be found in an rather old textbook of Clinical
Laboratory Diagnostics by L. Thomas (this book has its counterpart written
in German and its last edition is published in 2007).
Hope this helps.
Zeljko Debeljak, PhD
Medical Biochemistry Specialist
Osijek Clinical Hospital
CROATIA
>
>
> Hi, I'm looking for what may be a simple explanation which escapes me,
> for LFT results in a 67 y/o woman with paranoid psychiatric disorder who
> presents with ARF and the following LFT results:
>
>
>
> Bil 25 (ULN 22)
>
> ALT 2796 (<50)
>
> AST 137 (<50)
>
> ALP 230 (ULN 135)
>
> GGT 542 (<90)
>
>
>
> Her medication includes carbamazepine and quetiapine as well as
> omeprazole, gaviscon, asprin, T4 and lactulose.
>
> The history is unclear. There is a suggestion she may have overdosed but
> no clinical or biochem evidence of OD of the above or other usual
> agents. Clinicians are not convinced by this storey.
>
>
>
> The question surrounds the discrepancy between the ALT and AST results.
> This pattern has been repeated on follow up samples.
>
>
>
> I'd value any advice. Many thanks.
>
>
>
> Kind regards
>
> Janet Horner
>
>
>
>
>
>
>
>
>
>
>
>
>
>
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