What should a patient be told with elevated Blood Urea Nitrogen (BUN) and Aspartate Aminotransferase (AST) levels, high Alkaline Phosphatase (alk phos), and abnormal Vitamin B12 and Vitamin D levels?

From the Guidelines

I would tell the patient that their blood tests show some mild abnormalities in kidney function (BUN), liver function (AST and alkaline phosphatase), but these are not severely elevated and we should monitor them with follow-up testing, as suggested by the American Gastroenterological Association medical position statement 1. The patient's vitamin levels, including Vitamin B12 and Vitamin D, should be evaluated in the context of their overall clinical scenario, considering that an elevated Vitamin B12 level can be observed in myeloproliferative variants of hypereosinophilic syndrome, as noted in the NCCN clinical practice guidelines 1. However, based on the most recent evidence from the Journal of the American College of Radiology 1, the patient's elevated alkaline phosphatase level, in conjunction with other liver function tests, should be further evaluated to determine the etiology of potential cholestasis, and imaging of the biliary tree may be necessary. Key points to consider in the patient's evaluation include:

• The patient's clinical history and medications
• The presence of concomitant alkaline phosphatase elevations and other liver function tests
• The need for imaging of the biliary tree to determine the etiology of potential cholestasis
• The potential for chronic cholestatic processes, such as primary biliary cholangitis or primary sclerosing cholangitis, if the elevated alkaline phosphatase level persists over time. Given the complexity of the patient's presentation, a comprehensive approach, including laboratory testing and imaging, is necessary to establish a diagnosis and guide further management, as recommended by the American Gastroenterological Association medical position statement 1 and the Journal of the American College of Radiology 1.

From the Research

Elevated Blood Urea Nitrogen (BUN) and Aspartate Aminotransferase (AST) levels

• Elevated BUN and AST levels can indicate liver disease or damage, as well as other conditions such as kidney disease or muscle damage 2, 3, 4.
• The patient's medical history, physical examination, and other laboratory test results should be reviewed to determine the cause of the elevated levels 5, 4.

High Alkaline Phosphatase (alk phos) levels

• High alkaline phosphatase levels can indicate liver disease, bone disease, or other conditions such as pregnancy or certain medications 2, 3, 4.
• The patient's medical history, physical examination, and other laboratory test results should be reviewed to determine the cause of the elevated levels 5, 4.

Abnormal Vitamin B12 and Vitamin D levels

• Abnormal vitamin B12 levels can indicate liver disease, as well as other conditions such as nutritional deficiencies or certain medications 6.
• Abnormal vitamin D levels can indicate liver disease, as well as other conditions such as nutritional deficiencies or certain medications.
• The patient's medical history, physical examination, and other laboratory test results should be reviewed to determine the cause of the abnormal levels 5, 4.

Evaluation and Diagnosis

• A complete medical history, physical examination, and laboratory tests, including liver function tests and imaging studies, should be performed to evaluate the patient's condition and determine the cause of the abnormal test results 2, 3, 5, 4.
• The patient's risk factors, medical history, and physical examination results should be taken into account when interpreting the laboratory test results and determining the diagnosis 5, 4.