In fulminant hepatic failure, which marker is disproportionately elevated relative to others?

• A. AST
• B. ALT
• C. ALP
• D. Bilirubin

Answer: (A)

In fulminant hepatic failure, massive hepatocyte death releases enzymes into the blood, and the pattern of these elevations points to which enzyme dominates. The marker that rises disproportionately is AST. This is because AST exists in both cytosolic and mitochondrial parts of hepatocytes, and when severe necrosis occurs, mitochondrial membranes break down and release a large amount of AST. ALT, while elevated, is mainly cytosolic and does not rise as dramatically in this extreme injury. ALP and bilirubin reflect cholestasis and excretory problems, but they don’t surge to the same extent as the hepatocellular enzyme release in acute, massive liver cell death.