Published online: April 29, 2013
Question: A 57-year-old man was transferred to a tertiary care center owing to markedly elevated liver function tests. He was symptom free apart from nausea. His past medical history included poorly controlled type 2 diabetes mellitus, chronic renal impairment secondary to diabetes, right below-knee amputation, and left above-knee amputation owing to peripheral vascular disease. He was on insulin, metformin, ramipril, and aspirin. Physical examination was normal except for cushingoid features. Initial laboratory investigations revealed hemoglobin 10.5 g/dL (normal, 13.5–17.5); aspartate aminotransferase, >2600 U/L (normal, <40); alanine aminotransferase, 817 U/L (normal, <50); alkaline phosphatase, 1364 U/L (normal, 30–130); γ-glutamyl transferase, 718 U/L (normal, <70); total bilirubin, 0.88 mg/dL (normal, <1.0); creatinine, 1.69 mg/dL (normal, 0.7–1.4); urea, 66.9 mg/dL (normal, 8–18); albumin, 1.9 g/dL (normal, 3.5–5.0); lactate dehydrogenase >2700 U/L (normal, 100–225); and random glucose, 290.1 mg/dL (normal, 70–110).