From the Guidelines
Nausea and elevated ALT (alanine aminotransferase) suggest liver inflammation or dysfunction, and it is crucial to seek medical attention promptly for proper evaluation and treatment. The combination of nausea with elevated liver enzymes is concerning because ALT is released into the bloodstream when liver cells are damaged, as noted in a 2023 study published in the Journal of the American College of Radiology 1. Normal ALT levels are typically below 40 IU/L, and elevations can indicate various forms of liver injury.
In the meantime, it is essential to:
- Avoid alcohol, acetaminophen (Tylenol), and any medications or supplements that could stress your liver
- Stay hydrated with water
- Consider eating smaller, more frequent meals to help manage nausea
- Try ginger tea or candies for temporary nausea relief
Your doctor will likely order additional liver function tests, viral hepatitis screening, and possibly imaging studies like an ultrasound to determine the underlying cause of the elevated ALT, which could range from viral hepatitis, medication side effects, fatty liver disease, or other conditions, as discussed in another 2023 study published in the Journal of the American College of Radiology 1.
It is also important to consider other potential causes of liver disease, such as nonalcoholic fatty liver disease, autoimmune hepatitis, or Wilson’s disease, as mentioned in a 2010 study published in Hepatology 1. However, the most recent and highest quality studies suggest that the primary concern should be the evaluation and treatment of the underlying cause of the elevated ALT, rather than the consideration of other potential causes.
Seeking medical attention promptly is crucial, as early diagnosis and treatment can prevent further liver damage. Don't delay seeking medical attention, and follow your doctor's recommendations for further evaluation and treatment.
From the Research
Nausea and Elevated ALT
- Nausea can be a symptom of various conditions, including liver disorders, which can cause elevated Alanine Aminotransferase (ALT) levels 2, 3.
- Elevated ALT levels are commonly used as a biomarker for liver damage, with ALT being the most specific marker for liver damage compared to Aspartate Aminotransferase (AST) 2.
- The causes of elevated ALT levels can be diverse, including chronic alcohol consumption, drugs, non-alcoholic steatohepatitis (NASH), and chronic viral hepatitis 3.
- In some cases, elevated ALT levels may not be related to liver damage, but rather to non-hepatic causes such as polymyositis, acute muscle injury, acute myocardial infarction, or hypothyroidism 3.
Evaluation of Elevated ALT Levels
- The evaluation of elevated ALT levels should include testing for viral hepatitis A, B, and C, assessment for nonalcoholic fatty liver disease and alcoholic liver disease, screening for hereditary hemochromatosis, autoimmune hepatitis, Wilson's disease, and alpha-1 antitrypsin deficiency 4.
- A history of prescribed and over-the-counter medicines should also be sought, as some medications can cause liver injury 4.
- In cases where the cause of elevated ALT levels is unclear, a liver biopsy may be considered to elucidate a diagnosis, stage a condition, or when multiple diagnoses are possible 4.
- The degree of elevation of ALT and/or AST levels can help guide the evaluation, with higher levels indicating more severe liver damage 4.
Clinical Significance of Elevated ALT Levels
- Elevated ALT levels have been associated with increased liver-related mortality, emphasizing the importance of prompt evaluation and management 4.
- The presence of nausea in combination with elevated ALT levels may indicate a more severe underlying condition, such as liver disease or other hepatic disorders 2, 3.
- A thorough diagnostic work-up, including laboratory tests and imaging studies, is essential to determine the underlying cause of elevated ALT levels and nausea 5.