From the Guidelines
These liver enzyme values indicate liver inflammation, with ALT (100 units/L) being more significantly elevated than AST (45 units/L), suggesting a hepatocellular injury pattern that warrants further evaluation. The pattern of ALT elevation being higher than AST suggests an acute rather than chronic process, as AST typically exceeds ALT in chronic liver conditions 1. I recommend stopping any potentially hepatotoxic medications, avoiding alcohol completely, and scheduling an appointment with your healthcare provider within 1-2 weeks for a comprehensive workup. The evaluation should include:
- A complete liver panel
- Hepatitis serologies, including HAV-IgM, HBsAg, and Hepatitis B core antibody-IgM fraction (HBcIgM), HCV antibody (consider HCV-RNA) 1
- Possibly an ultrasound of the liver, although computerized tomography or abdominal magnetic resonance imaging may be preferable to ultrasonography in certain clinical scenarios 1 While waiting for your appointment, maintain a healthy diet low in processed foods and sugars, stay well-hydrated, and report any symptoms like jaundice, abdominal pain, or dark urine immediately. These enzyme elevations could be caused by various conditions including viral hepatitis, medication effects, alcohol use, or non-alcoholic fatty liver disease 1. Regular monitoring of these values will be important to track the progression or resolution of the underlying issue. Liver biopsy may be considered in patients with chronic HCV viremia and either normal or abnormal serum ALT levels 1.
From the Research
Interpretation of AST and ALT Levels
The provided AST and ALT levels are 45 and 100, respectively. To interpret these values, it is essential to consider the normal ranges and the potential causes of elevations.
Potential Causes of Elevated AST and ALT
- Non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH) 2
- Alcoholic liver disease 2
- Medication-associated liver injury 2
- Viral hepatitis (hepatitis B and C) 2
- Hemochromatosis 2
- Alpha-1 antitrypsin deficiency 2
- Autoimmune hepatitis 2
- Wilson's disease 3
- Celiac disease 3
- Medication-induced liver injury 3
- Ischemic hepatitis 3
Evaluation and Diagnostic Workup
The diagnostic workup for elevated AST and ALT levels should include:
- A complete medical history to identify risk factors for liver disease 4, 5
- A physical examination to identify signs of liver disease 4
- Laboratory tests, such as:
- Imaging studies, such as ultrasonography, if necessary 2
Next Steps
If the initial evaluation and laboratory tests do not reveal a cause for the elevated AST and ALT levels, further testing may be necessary to rule out less common causes of liver disease 2. Referral to a hepatologist may be recommended if transaminase levels remain elevated for six months or more 2.