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Correspondence |

RhabdomyolysisAminotransferases in Skeletal Muscle Disease: Some Extra Clues to Diagnosis FREE TO VIEW

Aibek E. Mirrakhimov, MD; Erkin M. Mirrakhimov, MD, PhD
Author and Funding Information

From the Department of Internal Medicine (Dr A. E. Mirrakhimov), Saint Joseph Hospital; and the Kyrgyz State Medical Academy (Dr E. A. Mirrakhimov).

Correspondence to: Aibek E. Mirrakhimov, MD, Saint Joseph Hospital, Department of Internal Medicine, 2900 N Lake Shore Dr, Chicago, IL 60657; e-mail: amirrakhimov1@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(2):415-416. doi:10.1378/chest.13-2126
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To the Editor:

We read the recently published article in CHEST (September 2013) by Zimmerman and Shen1 with interest. The authors prepared a high-quality review on the topic of rhabdomyolysis. It is essential to keep in mind that a considerable number of patients with rhabdomyolysis may lack clinical signs and symptoms.2 So what other clues can be helpful in detecting cases of skeletal muscle injury?

Some laboratory parameters can be of assistance that were not mentioned in the review article.1 Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations are laboratory tests typically included in a comprehensive metabolic panel. It is important to mention that both AST and ALT are present in skeletal muscle, with ALT being more specific to the liver.3 Patients with rhabdomyolysis tend to have abnormal aminotransferase in the absence of liver disease.3 In such cases, AST concentration tends to be higher than ALT concentration, and the AST to ALT ratio may be ≥ 2:1, similar to alcoholic liver disease.3

In supporting this notion, one of us (A. E. M.) recently took care of two patients with clinically asymptomatic rhabdomyolysis. Both patients had an AST to ALT ratio of 2:1, with no evidence or risk factors for liver disease. Neither patient had any muscle weakness or muscle tenderness. Creatine kinase level was elevated 15-fold in the first and 13-fold in the second patient. IV hydration was started. Therefore, it is essential to keep a high index of suspicion for rhabdomyolysis in an appropriate clinical setting with an elevated AST to ALT ratio.

References

Zimmerman JL, Shen MC. Rhabdomyolysis. Chest. 2013;144(3):1058-1065. [CrossRef] [PubMed]
 
Gabow PA, Kaehny WD, Kelleher SP. The spectrum of rhabdomyolysis. Medicine (Baltimore). 1982;61(3):141-152. [CrossRef] [PubMed]
 
Weibrecht K, Dayno M, Darling C, Bird SB. Liver aminotransferases are elevated with rhabdomyolysis in the absence of significant liver injury. J Med Toxicol. 2010;6(3):294-300. [CrossRef] [PubMed]
 

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References

Zimmerman JL, Shen MC. Rhabdomyolysis. Chest. 2013;144(3):1058-1065. [CrossRef] [PubMed]
 
Gabow PA, Kaehny WD, Kelleher SP. The spectrum of rhabdomyolysis. Medicine (Baltimore). 1982;61(3):141-152. [CrossRef] [PubMed]
 
Weibrecht K, Dayno M, Darling C, Bird SB. Liver aminotransferases are elevated with rhabdomyolysis in the absence of significant liver injury. J Med Toxicol. 2010;6(3):294-300. [CrossRef] [PubMed]
 
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