mildly elevated ast/alt -- cycling

[dmoran]

I am a 43 yr. old woman who has not had an alcoholic drink since roughly 1978 (never smoked -- I am a bit a "health nut"). My mom passed away at 43 yrs. from cirrhosis of the liver after a brief battle with alcoholism (she drank for 7 yrs. -- she drank mainly wine -- she was very thin, and it didn't take much for her to get drunk).

In the past 4-5 months I have put on about 15 lbs., mainly in the abdominal area. I rigidly watch my calories and know I have not increased intake -- certainly not enough to cause this weight gain. I do drink quite alot of water (about 2.5 gallons per day -- not due to excessive thirst -- more like a OCD thing -- the water "is there", so I drink it).

I have noticed over the years I am VERY sensitive to any chemicals taken in -- eg. 1/2 cup of decaf buzzes me out, then I get the low blood sugar drop feeling.

I RARELY will ever take medication -- one of those rare instances was on 11/5/04 wherein I took 4 acetaminophen's (500 mg. each) because of menstrual cramps -- normally I just take the cramps and deal with it.

On 11/22/2004 I had a blood test (I've been getting them on a quarterly basis lately to monitor my pernicious anemia, for which I take Intrinsi-B12). This recent test showed these liver enzyme results:

AST 67 iu/l(ref. range 0 - 40)
ALT 76 iu/l (rr. 0 - 40)
GGT 12 iu/l (rr. 0 - 60)
Serum Albumin 4.3g/dl (rr. 3.5 - 5.5)
Serum Total Protein 7.0 g/dl (rr. 6.0 - 8.5)
Total Globulin 2.7 g/dl (1.5 - 4.5)
A/G Ratio 1.6 (1.1 -2.5)
Total Bilirubin 0.5mg/dl (0.1 - 1.2)
LDH 200 iu/l (100 - 250)

Serum Phosphorus 4.9mg/dl (2.5 - 4.5)


TC = 1.7 mg/dl  HDL = 73 LDL = 55

In the past year my choloesterol took a tumble from 199 to a range between 129 - 138 (varying each test).

BEFORE the blood test I did my daily indoor cycle of 20 miles. I have been doing this daily for 15 years -- not sure if I'd classify this as strenuous. As a matter of fact, the past 3 blood tests wherein the AST/ALT were in the normal range had been done after the same exact workout regimen of 20 mi. on a Lifecycle, so I thinking I could rule it out as a culprit behind raising the AST/ALT...

1. Could the acetaminophen from 17 earlier have influenced the AST/ALT to elevate?

2. Could the cycling elevate the AST/ALT?

3. Since I don't have the traditional symptoms of cirrhosis (excepting the possible swelling of the adbomen -- which is most likely fat), should I not consider that as a possibilty?

[Kevin Pho, MD]

To answer your questions:
1) It is unlikely that Tylenol would be the cause, especially if it was taken so long ago.

2) It may be possible that strenuous muscle activity can slightly raise the AST/ALT - however, I would look for other causes first.  

3) I would consider testing for hepatitis as well as obtaining a liver ultrasound.  Things like fatty liver (which can be present if there is obesity present) can cause an elevation of the liver enzymes.

These options can be discussed with your personal physician.

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

[dmoran]

I forgot to add the primary part of my post!!! In the past 6 mos. I have had this intermittent smell of ammonia in my nostrils. sometimes it lasts all day -- sometimes it's very sporadic in the day. Gets exponentially heavy after I brush my teeth with baking soda at night (normally I use regular toothpaste). At times the ammonia smell will disappear for days - but no clear pattern as to when it happens has emerged.


THANKS!!

dorothy