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. 2000 Dec 1;46(12):2050–2068. doi: 10.1093/clinchem/46.12.2050

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© 2000 The American Association for Clinical Chemistry

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Figure 1. — Evaluation of suspected acute hepatic injury.

Initial evaluation of patients with signs and symptoms such as jaundice, fever, and right upper quadrant abdominal pain should be by measurement of aminotransferases. Marked increases (>3000 U/L) of either enzyme are usually attributable to ischemic or toxic liver injury; if history is negative for either, then the diagnostic workup should continue as in persons with smaller increases. Viral serologies are the principal tests for evaluation of acute hepatic injury, although the falling incidence of viral diseases has made other causes proportionally more common. Because both prescription and nonprescription drugs can cause acute injury, a detailed drug history is critical, particularly in those with increased ALP. In those with coexistent increases in ALP, obstruction and other viruses such as EBV and CMV must be considered as well. ALK, alkaline phosphatase; Nl, normal.