Vomiting-Induced Transaminitis

Clinical Context and Mechanism

The American College of Gastroenterology and the American Association for the Study of Liver Diseases acknowledge that vomiting can cause transaminitis, particularly in the context of hyperemesis gravidarum, where abnormal liver enzymes occur in approximately 50% of cases, though elevations are rarely greater than 1,000 IU/L and typically resolve with hydration and cessation of vomiting 1, 2
Hyperemesis gravidarum affects 0.35% to 2.0% of pregnancies and is characterized by persistent vomiting with weight loss ≥5% of prepregnancy body weight, dehydration and ketonuria, elevated transaminases in ~50% of cases, with ALT typically greater than AST, and rare elevations above 1,000 U/L 1, 2

The American College of Obstetricians and Gynecologists recommends that the biochemical abnormalities typically resolve with hydration and resolution of vomiting, which is the critical diagnostic and therapeutic feature, and treatment approach includes rehydration and correction of electrolyte abnormalities, thiamine supplementation, anti-emetic therapy, and nutritional support 1, 2

The American Association for the Study of Liver Diseases suggests considering other pregnancy-specific liver diseases that can present with nausea/vomiting, such as HELLP syndrome, acute fatty liver of pregnancy (AFLP), and intrahepatic cholestasis of pregnancy (ICP) 1, 2

The American College of Gastroenterology recommends expecting improvement within days of adequate hydration and anti-emetic therapy, rechecking liver enzymes after symptom resolution to confirm normalization, pursuing alternative diagnoses if transaminases remain elevated or worsen despite clinical improvement, and avoiding hepatotoxic medications during the acute phase 1, 2