Which laboratory test is most appropriate to monitor liver function during TB chemotherapy?

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Multiple Choice

Which laboratory test is most appropriate to monitor liver function during TB chemotherapy?

Monitoring liver effects during TB treatment hinges on detecting hepatocellular injury early. The best single lab for this is the liver transaminases—AST and ALT—as they rise with injury to liver cells and provide a sensitive signal of hepatotoxicity from TB drugs. Bilirubin elevations can occur later, often after substantial liver dysfunction or when there is cholestasis, so they’re less useful for early detection. Alkaline phosphatase can reflect bile flow issues or bone activity but isn’t specific for drug-induced hepatocellular injury. CBC doesn’t assess liver cell health directly. Baseline liver tests are important before starting therapy, with regular monitoring (often monthly) to catch rising AST/ALT early and guide management if values become elevated or if symptoms develop.

Monitoring liver effects during TB treatment hinges on detecting hepatocellular injury early. The best single lab for this is the liver transaminases—AST and ALT—as they rise with injury to liver cells and provide a sensitive signal of hepatotoxicity from TB drugs. Bilirubin elevations can occur later, often after substantial liver dysfunction or when there is cholestasis, so they’re less useful for early detection. Alkaline phosphatase can reflect bile flow issues or bone activity but isn’t specific for drug-induced hepatocellular injury. CBC doesn’t assess liver cell health directly. Baseline liver tests are important before starting therapy, with regular monitoring (often monthly) to catch rising AST/ALT early and guide management if values become elevated or if symptoms develop.

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