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AST 72, ALT 63 one week after having a drink. Is this typical?
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AST 72, ALT 63 one week after having a drink. Is this typical?

My lab lists normal ranges as AST 4-50, ALT 4-60.

Last year, labs were AST 48, ALT 28

This year, I had them tested about a week after having one mixed drink each on 2 consecutive nights. I'm not a drinker, typically 1-2 drinks (if at all) per month at social events. The first night, I had taken naproxen and forgotten, so that may be a factor. AST was 72, ALT was 63. Would this be considered abnormally high for someone who had a drink a week earlier?

Rather than waiting and testing them again, doctor ordered hepatitis test (negative) and a CT Scan.  Wouldn't it make sense to wait a few weeks and retest to see if enzymes return to normal rather than immediately jumping into a lot of radiation exposure?  Thanks in advance.
13 Comments Post a Comment
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4173379_tn?1355360151
Hi there...my husband had a recent diagnosis that involved liver enzymes being elevated...and it is a red flag for drs to also check out a patient's iron levels, not just what is on the CBC's but also the ferritin, transferrin saturation%, TIBC, and serum iron. If your enzymes are elevated and stay that way, and they have ruled out other causes like infection and virus or alcohol abuse or drugs/meds, then iron overload is another very common reason but usually undiagnosed condition. It was missed in my husband for many years. Iron overload causes the body to store excess iron and the the first organ affected is the liver, then the heart. So the further testing for iron overload, called hemochromatosis.

Left undetected iron overload destroys and damages organs, joints and tissues, leading to cirrhosis, diabetes, heart failure. It runs in families predominantly of European descent. My husband is Irish. His dad died of congestive heart failure, had colon cancer and HIS dad died of colon cancer as well. This disorder can run in families silently, as people die from or suffer from what we know are "common" ailments, like diabetes, arthritis, cancers, congestive heart failure, cirrhosis, and liver disease even in light of only moderate drinking, or even rare drinking.

Take care, and you can request copies of your blood work and lab results...if you have copies look and see if ferritin or transferrin saturation% (TSAT%) especially are on them.

Many people think their iron levels are checked on routine blood work but it is not, unless the dr orders this specifically. Hemoglobin can be a clue, but not always abnormal. High iron levels in conjunction with elevated liver enzymes is a very good clue. Also for liver enzymes get the GGT along with ALT and AST.
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978469_tn?1372339018
The ratio of AST being higher then ALT can be a problem. It should be the other way around. Google AST-ALT ratios
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446474_tn?1385271190
AST-ALT ration with AST greater than ALT is usually a sign of (inflammation of the liver) caused by alcohol damage or an indication of cirrhosis of the liver.

What was the results of the CT scan?
You should get a copy of it so you understand if you have cirrhosis. Only a biopsy can tell if your liver disease is caused by alcohol.

You should should get an appointment with either a gastroenterologist or hepatologist to find out what the cause of the elevated enzymes is.

Good luck.
Hector
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Avatar_m_tn
All my other LFT levels were normal.  Most were right in the middle of the 'normal' ranges.  Ferretin was 316, but my lab lists 345 at the top of that range.

I guess what I'm really trying to understand is, after someone has a drink (that is not a regular drinker), is it normal for enzymes to be elevated for short period of time (a few days, a week, etc)?
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Avatar_m_tn
Updated lab tests about 4 weeks after my initial test:

AST 54 (4-50)
ALT 34 (2-60)

Looks like they are headed in the right direction. Doctor doesn't think anymore investigation is needed.
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4173379_tn?1355360151
good news   :)

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Avatar_m_tn
Hi mattw76, I wanted to comment on your ferritin level...  

Different labs have different upper limits for the normal range for ferritin.  The most common upper limit is 300 (345 is an unusual/odd limit point), but whether 300 or 345, this limit is the point where you are officially overloaded with iron, and regardless of which limit you observe, being near (or slightly above) the limit is not necessarily good for optimal health.  

There is some newer thinking that high/normal iron is associated with increased risk for disease.  You don't state how old you are, but ferritin tends to creep up in males as they age.  Some say it's the reason women live longer than men, as menstruation keeps their iron low until they hit menopause.  

Do a google search for: Iron, too much of a good thing; and you should find several articles on this from different authors all sharing the same title.  

I would look into this further if I were you, and certainly add a ferritin lab to all your future bloodwork to keep tabs on this, as it tends to go only one direction in men, and that is UP.  

I don't know how you feel about needles, but iron is very easily lowered through blood donation.  The needle they use at the blood bank is LARGER than the one doctors use to draw labs with, but if this isn't a problem for you, it might be wise to look into lowering your iron.  

The "Iron Disorders Institute" website has a lot of information on iron and disease, and this would be a good place to visit to learn more about what dangers high or even high/normal iron can cause.  

Best of Luck to you!  
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4173379_tn?1355360151
100% agree on the weirdness of the reference range there...never saw that one before...commented to my hubbie on that one, too.

Just because someone falls within the "range" does not mean that you are ok..drs have a habit of being inhibited to further investigation by only looking for patients that flag for higher or lower "abnormal" levels, and many times these ranges are not sensitive enough for optimal or therapeutic health. Ferritin range is a good example of that. Being in the upper limit of a range is still cause for investigation...I don't know how I missed your previous post on your ferrtin, just saw the one you said your liver enzymes were coming down, which is good, but with ferritin like that I believe as well that the dr needs to do  little more digging, ie TSAT%, serum iron and TIBC, on top of the ferritin.

In early stages of iron accumulation you will not have really high ferritin OR liver enzymes. But your TSAT can also be elevated, which is a much better clue of iron storage.

Don't rule this out just yet until all the tests are in...if it continues to be higher than average levels, over time those numbers will climb, and you want to be the first to know. Family history is a good clue for conditions arising from iron overload. You can look up the info as WillinSD suggests.

Good thing to rule out as it is very common. Many types of iron overload disorders, not just hemochromatosis.

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Avatar_m_tn
Hi all, some more numbers from a few weeks ago when enzymes were elevated:

Iron 102 (45-170)
TIBC 315 (250-425)
% Saturation 32.4 (20-50%)
Ferritin 316 (20 - 345)


I'm in my mid 30's

Thanks again
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4173379_tn?1355360151
Thanks for posting those...

Just keep an eye based on those numbers that ferritin does not creep too high...elevated liver enzymes and ferritin can indicate virus or infection or some type of inflammation. You can look up causes of elevated ferritin. If iron levels are not also elevated, but ferritin and enzymes are, then keep in mind that ferritin can indicate something else. It is an acute phase reaction.

So take care of yourself, and keep on top of your numbers. Doing a good job of staying informed is the first step in our good health journey.
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Avatar_m_tn
Regarding the acute phase reaction...  (very good panda!)

During periods of infection (of many kinds) and/or inflammation (also of many kinds), the body can produce large amounts of empty ferritin in a desperate attempt to clean up any free iron in the body as free iron can feed infectious organisms and/or add to inflammation.  

This empty ferritin is called apoferritin and can cause a false positive for high iron.  The rest of the iron study then gives the better picture.  Your serum iron, trans-sat and iron binding capacity all look quite normal, and this takes us back to square one regarding auto-immune issues, infection or inflammation.  

The plot thickens!  As long as things keep heading in the right direction, what ever it was might have resolved and remain a mystery.  I'd keep a close watch on things (including iron) every few months until the high labs return to the middle third of their normal ranges.  

If the ferritin was a false positive (or nearly so) due to inflammation/infection, this should fall back into the middle third of it's normal range too.  

A search of the Iron Disorders Institute site for: ferritin, ideal range, shows 50 to 150, and a search for: optimal ferritin level,  under "iron tests", ferritin, shows 25 to 75 is actually the "optimal" range for best health.  
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Avatar_m_tn
Would having mono many years ago have any kind of lasting impact on liver enzymes?
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4173379_tn?1355360151
Did you have any issues with it? How were your symptoms? DId you have any problem with spleen? How long ago did you have this?

Most people don't have a recurrence of mono later on, but it can happen. If you are not having any symptoms that does not mean you aren't having a reactivation of it, but not likely. I don't think that if you had it that long ago that it would still be affecting your enzymes, unless there is active infection or virus going on. Elevated liver enzymes are an indication of some type of infection, inflammation, virus, or liver injury. So unless there is another mono infection happening, it is not likely the reason now all these years later.

Did you know you had mono or did it show up on a blood test recently that you actually had the virus? In some people, especially younger kids and adults, they don;t have severe symptoms and never know they had mono, and it can affect the spleen. Have you had a scan or ultra sound to see if your organs are enlarged?

I can tell you that the optimal (different from the reference range the lab uses) level for liver enzymes is 12-25 u/l...ALT, AST and GGT, same for all three.

ALT is usually the first to show indication of increase in liver conditions like liver congestion, fatty liver, congestion of spleen, lymph and immune system.

AST is a sensitive indicator of liver, heart, skeletal muscle, kidney and pancreas. It is increased in liver damage, also in heart, muscular damage, and in the cases of inflammation of pancreas it can rise.

GGT is indicator of liver function. Increased levels in hepatitis, cirrhosis, and pancreatitis.

You could have some infection or virus not manifesting itself yet, your body might be busy trying to fight it off, but you should really get to the bottom of it, and start with the above testing, the iron panel, and if ferritin alone is raised (optimal level less than 100) and the other iron tests are within optimal range (TSAT % no more than 45-50%, iron level between 17 and 24.5 umol/l) then the raised ferritin level on it's own can signify there is a virus or infection or inflammation going on you need to get checked out. Your electrolytes will also tell a good story, they are CBC's with differentials. You will see in your WBC, platelets and electrolytes just how well your body is doing fighting off infection, or isn't and how strong your immune system is.

Take care...hope all gets clear for you soon...I know what it's like having unanswered questions and waiting...

C
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