Follow-up Concerns After Rhabdomyolysis Discharge: AST and ALT Levels Rising
Hello everyone, I’m a 29-year-old male who recently experienced rhabdomyolysis after pushing myself too hard during a beginner spin class. I took the class on Thursday morning, and by Friday, I was suffering from severe leg pain and had discolored urine resembling cola. I went to the emergency room on Friday evening and spent approximately 18 hours receiving IV fluids. After that, I was discharged with instructions to maintain high fluid intake and schedule a blood test for the following Monday. Upon reviewing my latest bloodwork, I noticed that my AST and ALT levels have increased since my discharge, even though my creatine kinase (CK) levels have decreased. This spike in AST and ALT has made me anxious, but my doctor reassured me not to worry excessively and advised me to have another blood test done in ten days. Here’s a summary of my test results so far, with the initial results being from approximately 36 hours post-cycling session: ||0 Hrs (Friday evening)| |:-|:-| |Creatine Kinase|78,338| |AST|1,029| |ALT|295| |eGFR|>90| |LD|1,225| ||+12 HRS (Saturday midday)| |:-|:-| |Creatine Kinase|46,478| |AST|781| |ALT|255| |eGFR|>90| |LD|742| ||+60 HRS (Monday midday)| |:-|:-| |Creatine Kinase|32,000| |AST|912| |ALT|444| |eGFR|>90| |LD|956| My legs are gradually improving; while I can’t walk at my typical speed yet, I generally feel okay. Over the weekend, I made sure to stay well-hydrated and urinate frequently. The discharge summary sent to my physician noted the following: *At the time of discharge, my creatine kinase was 46,500, with normal renal function and an AST of 780. My ALT was reduced to 255. The medical staff requested to repeat the liver and renal function tests along with CK levels after 48 hours (scheduled for Monday 23/06).* Is there genuine cause for concern regarding the elevation in those values, or is it expected? Should I continue focusing on hydration until the follow-up in ten days? I’m open to any questions or additional requests for information regarding my test results. Thank you for your assistance!
Answers (1)
6/24/2025, 9:01:38 AM
OpenHealth AI
It’s great to hear that you’re feeling generally okay and that your legs are improving. Your concern regarding the rising AST and ALT levels after experiencing rhabdomyolysis is understandable, especially since you are closely monitoring your health.
Main Points:
- Rising AST and ALT levels can occur after muscle injury and may not indicate immediate liver damage.
- Continued hydration and monitoring symptoms are essential until your follow-up.
Explanation:
Rhabdomyolysis is a condition caused by the breakdown of muscle tissue resulting in the release of muscle fiber contents into the bloodstream, including enzymes like creatine kinase (CK), AST, and ALT. It's common for AST and ALT levels to rise in response to muscle injury, and in your case, this increase can happen even as CK levels decrease, as liver enzymes can take longer to normalize after the event.
Your current blood tests show fluctuating liver enzyme levels; while it's concerning to see the spikes, they can often return to baseline values with time. It's reassuring that your renal function remains normal (eGFR > 90) and CK levels are decreasing.
Next Steps:
- Continue Hydration: Ensure you are drinking plenty of fluids, as you've been advised. This helps kidneys excrete toxins effectively.
- Monitor Symptoms: Keep an eye on how you're feeling. If you experience any new or worsening symptoms, such as persistent abdominal pain, jaundice (yellowing of the skin/eyes), or worsening fatigue, be sure to reach out to your healthcare provider promptly.
- Follow-Up Testing: Stick to the plan for your follow-up blood test in ten days. This will help your physician monitor your liver function closely and adjust guidance as necessary.
- Rest and Recovery: Engage in light activities as tolerated, but avoid intense exercise or activities that could strain your muscles until cleared by your doctor.
You’re on the right path by staying informed and attentive to your health. If you have further questions or specific concerns about your recovery, don’t hesitate to discuss them with your healthcare provider during your next visit.
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