DOI: 10.1373/clinchem.2008.109033


A 43-year-old African-American man with a history of hypertension, depression, and chronic alcohol abuse presented to the emergency service of an outside hospital complaining of chest pain. Laboratory testing indicated hepatocellular injury with aspartate aminotransferase (AST)1 of 14000 U/L (reference interval 5–41 U/L) and alanine aminotransferase (ALT) of 6400 U/L (reference interval 8–45 U/L). Because laboratory indicators of liver function worsened, the patient was reinterviewed and confessed to having attempted suicide 3 days prior by ingesting about one-half gallon (approximately 4 L) of vodka and one-half bottle of extra-strength acetaminophen.