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Gastroenterology (Expert Forum)
Elevated ALT, AST, ALP in Type 1 Diabetic, 24 yrs. old
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Elevated ALT, AST, ALP in Type 1 Diabetic, 24 yrs. old
by MaddyKlein, Sep 27, 2004 12:00AM
My son is 24 and has been a Type 1 diabetic since the age of 19. He just graduated from college where he drank way too much in my opinion and didn’t particularly watch what he ate. He is 6’1 and weighs 240. He has always weight lifted and continues to go to the gym every other day. He bench presses 225.
His endocrinologist has been doing regular blood work since the onset of his diabetes. Since his college years, his ALT had gradually increased to 79 where it was in July. His doctor asked us to see his general practitioner who did a liver panel. His numbers follow:
Protein Total 7.1
Albumin Level 3.5
T Bil 1.7
D Bil 0.3
ALT 72
AST 59
Alk Phos 280
The Alk Phos are very high. The GP ordered a hepatitis panel (all negative) and did a cat scan (also came back normal). He has decided that we now should ‘wait’ 3 months and do more blood work. My son is no pain, has no symptoms and to look at him he would be a picture of good health.
His endocrinologist does not agree with the GP and thinks he should see a gastroenterologist.
He also had a CBC panel done in August, all normal ranges; see below:
WBC 9.9
RBC 4.99
Hgb 15.8
Hct 47.2
MCV 94.5
MCH 31.6
MCHC 33.4
RDW 13.7
Platelet 353
When he was very young 5-10 years old, he had ulcerative colitis which ended up being due to milk allergies. He has outgrown the milk allergy for the most part and hasn’t had an intestinal issues since.
What should we be doing ??? Does the muscle tearing that goes along with weight lifting warrant such high ALP levels? Should he see a Gastroenterologist to pursue further liver testing?
His A1C levels for the past 2 years have averaged 8.3.
His endocrinologist has been doing regular blood work since the onset of his diabetes. Since his college years, his ALT had gradually increased to 79 where it was in July. His doctor asked us to see his general practitioner who did a liver panel. His numbers follow:
Protein Total 7.1
Albumin Level 3.5
T Bil 1.7
D Bil 0.3
ALT 72
AST 59
Alk Phos 280
The Alk Phos are very high. The GP ordered a hepatitis panel (all negative) and did a cat scan (also came back normal). He has decided that we now should ‘wait’ 3 months and do more blood work. My son is no pain, has no symptoms and to look at him he would be a picture of good health.
His endocrinologist does not agree with the GP and thinks he should see a gastroenterologist.
He also had a CBC panel done in August, all normal ranges; see below:
WBC 9.9
RBC 4.99
Hgb 15.8
Hct 47.2
MCV 94.5
MCH 31.6
MCHC 33.4
RDW 13.7
Platelet 353
When he was very young 5-10 years old, he had ulcerative colitis which ended up being due to milk allergies. He has outgrown the milk allergy for the most part and hasn’t had an intestinal issues since.
What should we be doing ??? Does the muscle tearing that goes along with weight lifting warrant such high ALP levels? Should he see a Gastroenterologist to pursue further liver testing?
His A1C levels for the past 2 years have averaged 8.3.
Doctor's Answer
by Kevin Pho, MD, Sep 28, 2004 12:00AM
, Sep 28, 2004 12:00AM
An elevated alkaline phosphatase at those levels are relaively non-specific and can be caused by all types of liver disease. Other non-liver diseases can cause elevation, including lymphoma, osteomyelitis, and intraabdominal infections.
The ALT being mildly elevated deserves further evaluation. I would consider an ultrasound to image the liver - which can see diseases that may not be visualized with the CT scan. Abstaining from alcohol should certainly be considered. Following the liver enzymes on a serial basis is reasonable if all the tests are negative. You may want to discuss this and other possibilities in conjunction with a GI referral.
The only other test that may be helpful would be a biopsy, and this can be discussed with your GI physician. If the ALT is only 72, it is less likely that this would be considered, but discussing this option is certainly reasonable.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
The ALT being mildly elevated deserves further evaluation. I would consider an ultrasound to image the liver - which can see diseases that may not be visualized with the CT scan. Abstaining from alcohol should certainly be considered. Following the liver enzymes on a serial basis is reasonable if all the tests are negative. You may want to discuss this and other possibilities in conjunction with a GI referral.
The only other test that may be helpful would be a biopsy, and this can be discussed with your GI physician. If the ALT is only 72, it is less likely that this would be considered, but discussing this option is certainly reasonable.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
