Differential Diagnosis for Low Alk Phos with Elevated AST

• Single most likely diagnosis
  • Viral hepatitis: This condition often presents with elevated liver enzymes, including AST, and can have low alkaline phosphatase (alk phos) levels, especially in the acute phase.
• Other Likely diagnoses
  • Alcoholic liver disease: Chronic alcohol consumption can lead to liver damage, resulting in elevated AST and potentially low alk phos due to impaired liver function.
  • Non-alcoholic fatty liver disease (NAFLD): Similar to alcoholic liver disease, NAFLD can cause liver enzyme elevations, including AST, with variable effects on alk phos.
  • Medication-induced liver injury: Certain medications can cause liver damage, leading to elevated AST and alterations in alk phos levels.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Acute liver failure: Although less common, acute liver failure can present with low alk phos and significantly elevated AST, requiring prompt recognition and intervention.
  • Wilson's disease: A genetic disorder leading to copper accumulation in the liver, which can cause liver damage, elevated AST, and low alk phos.
  • Alpha-1 antitrypsin deficiency: A genetic disorder that can lead to liver disease, characterized by low alk phos and elevated AST in some cases.
• Rare diagnoses
  • Glycogen storage diseases: Certain types of glycogen storage diseases can affect the liver, leading to abnormal liver enzyme levels, including low alk phos and elevated AST.
  • Fructose intolerance: A rare genetic disorder that can cause liver dysfunction, resulting in abnormal liver enzyme levels, including AST and alk phos.