Elevated AST and ALT puzzle...Help?

[mskslr]

My mom was diagnosed with advanced liver disease from alcoholism, Hep C (tainted blood), portal hypertension manifested by varices pancytopenia, and asthma. She was hospitalized in 5/02 for broken hip (pins, plate in trochanter) and again in 6/1/02 for a pain medication overdose (was confused,hallucinating). She had taken Darvocet(N 100) and some cough medicine (with codeine?)

Although she stopped drinking altogether in 4/01 after GI bleeding and banded varices, her GI thinks she still drinks. Can't understand why. His reasoning: during the 6/1/02 hospitalization, labs said:
MCV: 107
AST: 55
ALT: 17
Blood Alco: 0
INR elevated: 1.3
Blood Cell count: 3000
Hemoglobin: 8.1
platelet ct: 50,000
Diag. on the 6/1/02 visit: hypokalemia, hyponatremia,hypochloremia.

I do not know what (if anything) the ER gave her before the 6/1/02 blood was drawn.

I wish I knew what else is relevent.Could this be?

Before she broke her hip (5/02), on 3/7/02 her AST was 25, ALT was 11.(MCV 116.3H).
She was admitted after her hip fracture in 1/10/03 and her
AST was 29 and ALT was 11.  But on 1/12/03, her AST was 141 and ALT was 33 (still in hosp.)

Based on the 6/1/02 labs, could the GI conclude she was still drinking? What may have been other causes for elevated AST? ALT?

These issues are still very much present, as well.

Thank you so much for your response!

[Kevin Pho, MD]

A ratio where the AST is greater than the ALT is strongly suggestive of alcohol as a cause of liver disease.  The elevated MCV is also suggestive as well.

Of course, there can be other causes - like hepatitis, or anatomical abnormalities.  

The low platelet count as well as an elevated INR is suggestive of relatively advanced disease.

You can consider an ultrasound for further evaluation of the liver, as well as to help determine the severity of the disease.

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

[Sarah Connors]

In my opinion GGT is more specific indicator of Alcoholic liver disease as are compared to raised ALT levels & increased MCV which are comparatively non specific as raised ALT is a sign of liver cell injury from any cause.
Low platelet count indicates splenomegaly, due to any cause of advanced liver disease.
In monitoring such a patient a rise or fall in GGT will strongly be indicative of the patient’s drinking habits.

[mskslr]

Thank you for your thoughts. My biggest question remains:
do those levels show that she had returned to drinking?
She stopped, but do the levels show that she had started again?
(Do they show recent use?)

Look forward to your thoughts.

[Sarah Connors]

In your post you haven’t mentioned her GGT levels. (Which usually is a part of liver function tests?)
I would have to see 2 values of GGT levels, for comparison to give my personal opinion about that.
The liver enzyme levels etc that you have posted just suggest that the patient has advanced liver disease which can have several causes, it was only you who made me & every one realize that drinking & Hep C are the main culprits.

[Sarah Connors]

& please specify the exact units for ALT, AST GGT. e.g. IU/L, ummol/l etc.

[mskslr]

Thank you, Sarah. Will research these and get back to you this morning. Very interesting....

[Sarah Connors]

You are welcome.

Sarah Connors M.D
Sarah_123_Tampa***@****