From the Guidelines
The patient's lab results indicate liver inflammation or injury, and I recommend further evaluation of liver function with additional testing, including GGT, bilirubin fractionation, hepatitis panel, and abdominal ultrasound, as suggested by the American Gastroenterological Association medical position statement 1. The lab results show several abnormalities that require attention, including elevated liver enzymes (AST 46, ALT 69, alkaline phosphatase 129), which suggest liver inflammation or injury.
- The patient's low BUN/creatinine ratio (8) and low carbon dioxide (19) may indicate possible metabolic acidosis, and obtaining arterial blood gases to confirm and assess severity is necessary.
- The patient should temporarily avoid hepatotoxic medications, including acetaminophen, NSAIDs, and alcohol, as recommended by the guidelines for evaluating serum liver chemistries 1.
- Hydration should be encouraged with 2-3 liters of water daily, and follow-up labs should be scheduled in 2-4 weeks to monitor liver enzymes.
- If the patient has symptoms like fatigue, abdominal pain, or jaundice, they should be evaluated sooner, taking into account the clinical context of the patient, as emphasized by the American Gastroenterological Association medical position statement 1. The normal glucose, electrolytes, and kidney function (normal creatinine and eGFR) are reassuring findings that suggest the issues are primarily hepatic rather than renal in nature.
- A dietary assessment would be beneficial to address the low BUN, which may indicate overhydration or malnutrition.
- The interpretation of all abnormal liver chemistries must be taken in the clinical context of a given patient, as stated in the guidelines for evaluating serum liver chemistries 1.
From the Research
Interpretation of Laboratory Results
- Glucose level is 86, which is within the normal range.
- BUN (Blood Urea Nitrogen) level is 5, which is below the low normal range.
- Creatinine level is 0.61, which is within the normal range.
- eGFR (estimated Glomerular Filtration Rate) is 126, which is within the normal range.
- BUN/creatinine ratio is 8, which is below the low normal range.
- Sodium level is 138, which is within the normal range.
- Potassium level is 4.5, which is within the normal range.
- Chloride level is 103, which is within the normal range.
- Carbon dioxide, total level is 19, which is below the low normal range.
- Calcium level is 9.2, which is within the normal range.
- Protein, total level is 7.1, which is within the normal range.
- Albumin level is 4.4, which is within the normal range.
- Globulin, total level is 2.7, which is within the normal range.
- Bilirubin, total level is <0.2, which is within the normal range.
- Alkaline phosphatase level is 129, which is above the high normal range.
- AST (SGOT) level is 46, which is above the high normal range.
- ALT (SGPT) level is 69, which is above the high normal range.
Treatment Plan
- The elevated levels of AST and ALT suggest liver injury or disease 2, 3, 4, 5.
- The patient may benefit from treatment with ursodeoxycholic acid (UDCA) or a combination of vitamin E and vitamin C 2, 3, 4, 5.
- A systematic, stepwise approach to the evaluation and management of abnormal liver test results is recommended to optimize high-value care 6.
- The patient's history and examination should be taken into account when interpreting the laboratory results and guiding diagnostic evaluation with serologic testing and liver imaging 6.
- The combination of UDCA with vitamin E may be a therapeutic option for nonalcoholic steatohepatitis (NASH) and has been shown to improve liver function tests in long-term 5.
- Vitamin E plus vitamin C combination treatment is a safe, inexpensive and effective treatment option in patients with fatty liver disease, with results comparable to those obtained with UDCA 4.