A 24-year-old woman tried to commit suicide by ingesting a bottle of acetaminophen. Laboratory data showed massive liver cell necrosis
Which of the following laboratory findings indicates that the liver has a reduced capacity to synthesize proteins?
A. elevated serum alanine transaminase
B. elevated serum aspartate transaminase
C. elevated serum bilirubin
D. elevated alkaline phosphatase
E. prolonged prothrombin time
E
Damaged liver cells cannot synthesize proteins, and thus the concentration of liver-derived proteins decreases at a rate reflecting the half-life of these plasma proteins. Reduced levels of coagulation proteins cause prolongation of prothrombin time, which is a very sensitive test of reduced synthetic activity of the liver. Transaminases are markers of liver cell necrosis. Alkaline phosphatase is generally a marker of cholestasis and biliary obstruction, but mildly elevated serum levels of alkaline phosphatase are found in liver cell necrosis as well. Bilirubin is elevated in many liver diseases, which does not reflect the capacity of liver cells to synthesize proteins.
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