Severely elevated transaminases

Severely elevated ALT/AST (>10000) indicates extensive hepatic necrosis. Common causes include:

• ischemia, shock (prolonged hypotension/circulatory collapse)
• acute toxic insult (acetaminophen toxicity, mushrooms: Amanita phalloides)
• Severe viral hepatitis

This is in contrast to:

• moderately elevated ALT/AST (high hundreds to thousands): acute viral hepatitis

• mildly elevated ALT/AST (low hundreds): chronic viral hepatitis, acute alcoholic hepatitis.