From the Guidelines
A sudden doubling of AST levels in one day is most likely caused by acute liver injury or damage, such as medication toxicity, viral hepatitis, or ischemic hepatitis, as evidenced by the recent study on abnormal liver function tests 1. The causes of a sudden doubling of AST levels can be multifaceted, but the most common ones include:
- Medication toxicity, especially acetaminophen overdose
- Viral hepatitis, particularly hepatitis A, B, or E
- Alcoholic hepatitis from binge drinking
- Ischemic hepatitis due to severe hypotension or heart failure
- Acute biliary obstruction Other possibilities include autoimmune hepatitis flares, herbal supplement reactions, mushroom poisoning, or severe systemic infections. The rapid rise in AST levels occurs because the enzyme is released when liver cells are damaged, and it has a short half-life of about 17 hours, making it a sensitive marker for acute injury, as noted in the study on abnormal liver function tests 1. It is essential to seek immediate medical attention for proper diagnosis through additional liver function tests, imaging, and possibly liver biopsy, as the treatment depends on identifying and addressing the underlying cause, which may include stopping hepatotoxic medications, supportive care, or specific interventions for the identified condition.
From the Research
Causes of AST Doubling in 1 Day
- Skeletal muscle damage: This is a common cause of markedly elevated AST levels, as seen in the study by 2. The magnitude of the peak AST level significantly correlated with 30-day mortality.
- Cardiac muscle damage: Cardiac muscle damage is another etiology of markedly elevated AST levels, as reported in the study by 2. The 30-day mortality rate for cardiac muscle damage was 19.5%.
- Hematologic disorder: Hematologic disorders can also cause markedly elevated AST levels, with a 30-day mortality rate of 65.5%, as seen in the study by 2.
- Liver disorders: Although AST is not the most specific marker for liver damage, as stated in the study by 3, liver disorders such as hepatocellular injury can cause elevated AST levels. The evaluation of hepatocellular injury includes testing for viral hepatitis, nonalcoholic fatty liver disease, and alcoholic liver disease, as outlined in the study by 4.
- Other causes: Other causes of elevated AST levels include myocardial infarction, as seen in the case report by 3, and other non-hepatic causes, as discussed in the study by 2.
Factors Associated with AST Elevation
- Peak AST level: The magnitude of the peak AST level significantly correlated with 30-day mortality, as seen in the study by 2.
- Etiology: The etiology of the AST elevation, such as skeletal muscle damage, cardiac muscle damage, or hematologic disorder, can affect the survival rate, as reported in the study by 2.