Elevated Liver Enzymes - no history

[dhind]

I am a 43 year old white, female in excellent health.  I am 5'5 and 125 pounds.  I exercise regularly, drink alcohol only on rare occassions, and have no drug history of any kind. My only health issue is a fibroid tumor (rather large)causing heavy menstruation leading to chronic anemia. That is how I discovered the elevated ALT and ASTs. My Hgb was 8.1 and I put myself on large amounts of iron (50 mg daily).  IN three months, my hemoglobin went up to 12.3.  I am an RN in the ER so I can have my blood drawn frequently at will.  I had a negative hepatitis panel 2 months ago, so that is not the cause. One three seperate occassions I had my blood drawn and noted the following:  The AST and ALT were elevated (I think the AST was around 100 and the ALT was 45). Apx. 3 months later, the ALT was normal and the AST was very near normal.  Today's results reflected the following: AST = 118, ALT = 177.  Also included on this panel was the ALP-L =166 and the LDH1L - 230.  Lipid profile was done on the second set of my blood work and looked very good. I have been taking supplements since the 3RD SET of labs here ONLY.  B's,multivitamin, extra E (no extra A) and glucosamine.  ALso I have been taking Augmentin (again, on the 3rd set of enzymes only). Also Mortin around the clock on the 3rd set (for an acute, minor running injury that I developed recently.
What could be causing these enzymes to be sporadic like this?  I am in very good health and in good shape.  I have done a higher protein diet (70 grams daily)while trying to keep carbs low.  I sometimes do protein shakes from the healthstores (sometimes they have creatine in them).  Could any of these supplements be the culprit? Could the large fibroid be releasing toxins???

[Kevin Pho, MD]

I am unaware of a fibroid releasing toxins that can raise the liver function panel.  It is possible that the Motrin or Augmentin can raise the liver function tests - you may want to consider repeating the tests after elimination of these medications.

Other tests to consider would be a repeat hepatitis screen, ANA level (to evaluate for autoimmune hepatitis) as well as an abdominal ultrasound (which can evaluate for fatty liver, anatomical liver disease, or gallbladder disease).

If all the tests are negative and the liver enzymes remain above 100, a liver biopsy can be considered to further evaluate the cause.  This can be discussed with a GI specialist.

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.

Thanks,
Kevin, M.D.

[sandybliv]

Hi, your letter sounded just like mine (except I am a breast cancer survior and on Tomoxfin, Nexium).  My liver enzymes flucated as your did.  I had a slight elevation, then a jump into the triple digits.  I had a biopsy on April 8, still waiting for the results.  My dr. tested for liver disease, cirrohois (I do not drink alot and have been abstaining) iron overload, hepatitis etc.  In October I had a CT Abdomen scan, pelvis for abnormal liver chemistries.  My lung bases were clear, liver enhances appropriately, portal vein and hepatic veins wre normal.  Liver contour remarkable, no bilary dilation seen, gallbladder good, pancreas unremarkable, spleen normal, Adrenals normal.  Kidneys normal except for a 1.8 cmy cust, some abdominal aorta clacifications but no aneurysm.  Plevis reveal a bibroid uterus with clacified fibroids.  Impression: 1. unremarkable liver, save, liver cyst, unremarkable exam.  

Not to bore you with the above, but even though my scan in October was normal, my GI sent me for a liver biopsy to discover why I had elevated enzymes.
Good Luck, let me know how you make out.