ASPARTATE AMINOTRANSFERASE ELEVATION

Ask the following questions:

1. Is the patient receiving heparin therapy? As many as 27% of patients taking heparin have an elevated aspartate aminotransferase [AST, or serum glutamine-oxaloacetic transaminase (SGOT)], and 60% have an elevated alanine aminotransferase (ALT).
2. Are the results of liver function tests abnormal? This indicates that the elevated AST is due to liver disease.
3. Is the creatine phosphokinase (CPK) elevated? An elevated CPK would indicate that the elevated AST is related to muscle damage or disease or a myocardial infarction. Further differentiation of these two conditions is made by ordering CPK isoenzymes and an EKG.
4. What is the arm-to-tongue circulation time? This is increased in congestive heart failure.
5. Is the serum amylase elevated? This would point to pancreatitis as the cause of the AST elevation. If all of the above related tests are normal, the AST elevation is most likely due to liver disease or renal infarction.

DIAGNOSTIC WORKUP

Additional tests to order that will help pin down the diagnosis include a CBC, serum amylase, chemistry panel, lactic acid dehydrogenase (LDH) isoenzymes, γ -glutamyltransferase, urinalysis, serial EKGs, pulmonary function tests, chest x-ray, flat plate of the abdomen, electromyography (EMG), liver biopsy, and muscle biopsy. Consultation with a cardiologist or hepatologist would be prudent before ordering expensive diagnostic tests.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Increased intracranial pressure: Introduction (review 61 causes)
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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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