Strenuous Exercise-Induced Tremendously Elevated Transaminases Levels in a Healthy Adult: A Diagnostic Dilemma

Khatri, Prabin; Neupane, Aryan; Sapkota, Suman; Bashyal, Bibhav; Sharma, Dipesh; Chhetri, Ashmita; Chirag, K C; Banjade, Ashish; Sapkota, Priyanka; Bhandari, Subarna

doi:10.1155/2021/6653266

Cited by 8 publications

(8 citation statements)

References 4 publications

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“…The increase in liver function tests is generally accepted as a biomarker of liver injury. We acknowledge that skeletal muscle injury can also induce an isolated increase of ALT and/or AST (Pettersson et al, 2008;Khatri et al, 2021). However, this was not probably the case in our patient, as increased levels of ALT and AST were also accompanied by increased levels of bilirubin and ALP.…”

Section: Two-peak Myoglobinemiamentioning

confidence: 65%

Pervitin Intoxication with Two-peak Massive Myoglobinemia, Acute Kidney Injury and Marked Procalcitonin Increase Not Associated with Sepsis

2022

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Patients intoxicated with methamphetamine-like substances may present with myoglobinuria but rarely require admission. An 18-year-old female was admitted due to intoxication with pervitin, a methamphetamine derivative. She presented with an altered mental status, fever, and increased heart and respiratory rates. Biomarkers showed leukocytosis and markedly increased procalcitonin levels, suggestive of sepsis. However, blood cultures and infectious disease workup were unrevealing. Clinical course was heralded by rhabdomyolysis and myoglobinuria resulting in multi-organ failure including respiratory failure necessitating mechanical ventilation, hemodynamic compromise with need for inotropic support, and an acute renal failure requiring renal replacement therapy. Surprisingly, after a transient improvement, an unexpected second peak of myoglobin was observed on hospital day 5, controlled by intensifying the elimination methods, and administration of dantrolene. Acute kidney injury resolved by hospital day 15, and the patient could be discharged on day 22. While most patients with intoxications are discharged within 24 hours from emergency departments without being admitted, our case report highlights that the organ injury may evolve beyond the usual observation period, traditional renal-replacement therapies may not be sufficient to mitigate myoglobinemia with resulting acute kidney injury, and that procalcitonin may not be a reliable biomarker of infection in the setting of drug-induced rhabdomyolysis.

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Section: Two-peak Myoglobinemiamentioning

confidence: 65%

Pervitin Intoxication with Two-peak Massive Myoglobinemia, Acute Kidney Injury and Marked Procalcitonin Increase Not Associated with Sepsis

2022

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“…Despite several case reports[ 7 8 9 ] and one controlled study[ 6 ] showing acute transaminitis following intense exercise training in otherwise healthy adults, this clinical case makes at least three unique observations. First, transaminitis following intense exercise has not been observed alongside elevated GGT.…”

Section: Discussionmentioning

confidence: 88%

Exercise-induced increases in “liver function tests” in a healthy adult male: Is there a knowledge gap in primary care?

Tiller¹,

Stringer²

2023

Journal of Family Medicine and Primary Care

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A BSTRACT A routine clinical assessment in a 39-year-old male revealed liver function tests at 1.4–2.3 times the normal limit. He was asymptomatic, had no personal/family history of liver disease, and did not drink or use recreational drugs. He was in good physical condition and engaged in regular running and resistance exercise. Negative workup included tests for hepatitis A, B, and C, M-proteins, and antimitochondrial antibodies. Abdominal ultrasound was unremarkable. The patient was referred to a gastroenterologist who ordered repeat liver function tests (LFTs) and a liver biopsy. Before his follow-up assessment the patient abstained from exercise for seven days, after which all LFTs had normalized. The abnormal liver panel was thus likely due to exercise-induced muscle damage and/or changes in hepatocyte membrane permeability. Importantly, the diagnostic pathway did not include any assessment of muscle biomarkers (e.g., creatine kinase) or the patient’s exercise training habits. This case highlights a knowledge gap in primary care regarding the possible causes of LFT abnormalities in young adults.

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“…The serum levels of ALT, AST, and ALP are indicators of liver damage, and they increase during liver cell damage or inflammation. Importantly, vigorous exercise can also increase the serum levels of these enzymes [ 46 , 47 ]. LDH and CK levels are closely related to muscle damage.…”

Section: Discussionmentioning

confidence: 99%

Effect of HY7602 Fermented Deer Antler on Physical Fatigue and Antioxidant Activity in Mice

Jeon,

Lee,

Kim

et al. 2024

IJMS

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Lactobacillus curvatus HY7602 fermented antler (FA) ameliorates sarcopenia and improves exercise performance by increasing muscle mass, muscle fiber regeneration, and mitochondrial biogenesis; however, its anti-fatigue and antioxidant effects have not been studied. Therefore, this study aimed to investigate the anti-fatigue and antioxidant effects and mechanisms of FA. C2C12 and HepG2 cells were stimulated with 1 mM of hydrogen peroxide (H2O2) to induce oxidative stress, followed by treatment with FA. Additionally, 44-week-old C57BL/6J mice were orally administered FA for 4 weeks. FA treatment (5–100 μg/mL) significantly attenuated H2O2-induced cytotoxicity and reactive oxygen species (ROS) production in both cell lines in a dose-dependent manner. In vivo experiments showed that FA treatment significantly increased the mobility time of mice in the forced swimming test and significantly downregulated the serum levels of alanine aminotransferase (ALT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), creatine kinase (CK), and lactate. Notably, FA treatment significantly upregulated the activities of the antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), and glutathione/oxidized glutathione ratio (GSH/GSSG) and increased the mRNA expression of antioxidant genes (SOD1, SOD2, CAT, GPx1, GPx2, and GSR) in the liver. Conclusively, FA is a potentially useful functional food ingredient for improving fatigue through its antioxidant effects.

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Strenuous Exercise-Induced Tremendously Elevated Transaminases Levels in a Healthy Adult: A Diagnostic Dilemma

Cited by 8 publications

References 4 publications

Pervitin Intoxication with Two-peak Massive Myoglobinemia, Acute Kidney Injury and Marked Procalcitonin Increase Not Associated with Sepsis

Pervitin Intoxication with Two-peak Massive Myoglobinemia, Acute Kidney Injury and Marked Procalcitonin Increase Not Associated with Sepsis

Exercise-induced increases in “liver function tests” in a healthy adult male: Is there a knowledge gap in primary care?

Effect of HY7602 Fermented Deer Antler on Physical Fatigue and Antioxidant Activity in Mice

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