{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T07:33:03Z","timestamp":1751355183163,"version":"3.40.5"},"reference-count":5,"publisher":"American Academy of Insurance Medicine","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Insur Med"],"published-print":{"date-parts":[[2023]]},"abstract":"Detecting undisclosed methamphetamine and heroin abuse is a challenge for life underwriters and medical directors. A common clinical assumption is that if substance abusers experience liver damage, it will be indicated by elevated serum transaminases. The following case suggests that assumption may not be true for heavy substance abusers who consume no or minimal alcohol.<\/jats:p>\n This report describes a 44-year-old male with long-term use of inhaled combined methamphetamine and heroin (\u201cspeedballs\u201d) and minimal alcohol use, whose transaminases remained normal while episodes of acute liver failure and transient hepatic encephalopathy from hyperammonemia were observed. In this case, a fatal motor vehicle accident occurred following the sudden onset of hepatic encephalopathy hours after consuming a \u201cspeedball.\u201d<\/jats:p>\n Normal transaminases may not be proof of a normal healthy liver among methamphetamine and heroin abusers.<\/jats:p>","DOI":"10.17849\/insm-49-4-2-4.1","type":"journal-article","created":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T14:25:03Z","timestamp":1675952703000},"page":"250-253","source":"Crossref","is-referenced-by-count":1,"title":["Normal Transaminases in Methamphetamine- and Heroin-Associated Hyperammonemic Encephalopathy"],"prefix":"10.17849","volume":"49","author":[{"given":"Vera F.","family":"Dolan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"7324","reference":[{"key":"i0743-6661-49-4-250-ref1","series-title":"Am J Gastroenterol","first-page":"18","article-title":"ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries","volume":"112","author":"Kwo","year":"2017","unstructured":"Kwo\n PY,\n \n \n Cohen\n SM,\n \n \n Lim\n JK.\n \n \n ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries.\n\t\t\t\t\tAm J Gastroenterol2017;\n\t\t\t\t\t112:\n\t\t\t\t\t18-\n\t\t\t\t\t35."},{"key":"i0743-6661-49-4-250-ref2","series-title":"J. Clin Psychopharmacol.","first-page":"92","article-title":"Methamphetamine-associated hyperammonemic encephalopathy \u2013 case report","volume":"42","author":"Jannatabadi","year":"2022","unstructured":"Jannatabadi\n NA,\n \n \n et\u00a0al.\n Methamphetamine-associated hyperammonemic encephalopathy \u2013 case report.\n\t\t\t\t\tJ. Clin Psychopharmacol.2022;\n\t\t\t\t\t42:\n\t\t\t\t\t92-\n\t\t\t\t\t94."},{"key":"i0743-6661-49-4-250-ref3","series-title":"Metab Brain Dis","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1007\/s11011-020-00549-8","article-title":"Astrocyte swelling in hepat-ic encephalopathy: molecular perspective of cytotoxic edema","volume":"35","author":"Sepehrinezhad","year":"2020","unstructured":"Sepehrinezhad\n A,\n \n \n Zarifkar\n A,\n \n \n Namvar\n G,\n \n \n Ali Shahbazi\n A,\n \n \n Williams\n R.\n \n \n Astrocyte swelling in hepat-ic encephalopathy: molecular perspective of cytotoxic edema.\n\t\t\t\t\tMetab Brain Dis. 2020;\n\t\t\t\t\t35:\n\t\t\t\t\t559-\n\t\t\t\t\t578. doi:\n\t\t\t\t\t10.1007\/s11011-020-00549-8. Epub 2020 Mar 7."},{"key":"i0743-6661-49-4-250-ref4","series-title":"Drugs","first-page":"55","article-title":"Hepatic encephalopathy: Definition, clinical grading and diagnostic principles","volume":"79","author":"Weissenborn","year":"2019","unstructured":"Weissenborn\n K.\n \n \n Hepatic encephalopathy: Definition, clinical grading and diagnostic principles.\n\t\t\t\t\tDrugs.\n\t\t\t\t\t2019:\n\t\t\t\t\t79(Suppl 1):\n\t\t\t\t\t55-\n\t\t\t\t\t59."},{"key":"i0743-6661-49-4-250-ref5","series-title":"Clin Liver Dis","first-page":"219","article-title":"Prognosis of hepatic encephalopathy","volume":"24","author":"Krishnarao","year":"2020","unstructured":"Krishnarao\n A\n and\n\t\t\t\t\t\tGordonFD.\n Prognosis of hepatic encephalopathy.\n\t\t\t\t\tClin Liver Dis.\n\t\t\t\t\t2020;\n\t\t\t\t\t24:\n\t\t\t\t\t219-\n\t\t\t\t\t229."}],"container-title":["Journal of Insurance Medicine"],"original-title":[],"link":[{"URL":"https:\/\/jim.kglmeridian.com\/view\/journals\/insm\/49\/4\/article-p250.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/meridian.allenpress.com\/jim\/article-pdf\/49\/4\/250\/3210412\/i0743-6661-49-4-250.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jim.kglmeridian.com\/downloadpdf\/journals\/insm\/49\/4\/article-p250.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jim.kglmeridian.com\/downloadpdf\/journals\/insm\/49\/4\/article-p250.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:38:58Z","timestamp":1747355938000},"score":1,"resource":{"primary":{"URL":"https:\/\/jim.kglmeridian.com\/view\/journals\/insm\/49\/4\/article-p250.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023]]},"references-count":5,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.17849\/insm-49-4-2-4.1","relation":{},"ISSN":["0743-6661"],"issn-type":[{"type":"print","value":"0743-6661"}],"subject":[],"published":{"date-parts":[[2023]]}}}