40:
93:(though they are not the only enzymes in the liver). Normal ranges for both ALT and AST vary by gender, age, and geography and are roughly 8-40 U/L (0.14-0.67 ÎĽkal/L). Mild transaminesemia refers to levels up to 250 U/L. Drug-induced increases such as that found with the use of anti-tuberculosis agents such as
109:
commonly reach values for both ALT and AST in the >1000 U/L range; however, many people with liver disease have normal transaminases. Elevated transaminases that persist less than six months are termed "acute" in nature, and those values that persist for six months or more are termed "chronic" in
195:
In general, any damage to the liver will cause medium elevations in these transaminases, but diagnosis requires synthesis of many pieces of information, including the patient's history, physical examination, and possibly imaging or other laboratory examinations. However, very high elevations of the
186:
Possible causes for high ALT levels are liver inflammation (hepatitis A, B, C, infectious mononucleosis, acute viral fever, alcohol, pancreatic disorder), injury to muscles (trauma, myocardial infarction, congestive heart failure, acute kidney failure), and many toxins and drugs.
231:" (URL), also known as the "upper limit of normal" (ULN), which depend on the source and are typically 40-50 U/L (0.67-0.83 ÎĽkal/L) for both AST and ALT. While values vary between individuals, the following are typical AST and ALT patterns:
219:, and they may come from tissues other than liver (such as muscle). For example, intense exercise such as weight lifting can increase ALT to 50-200 U/L, and AST to 100-1000 U/L for the week following the exercise.
999:
984:
227:
The magnitude of AST and ALT elevations vary depending on the cause of the increase, such as intensity of recent muscular exertion or type of hepatocellular injury. The following refer to the "
200:, liver injury from lack of blood flow, or injury from drugs or toxins. Most disease processes cause ALT to rise higher than AST; AST levels double or triple that of ALT are consistent with
97:
are limited typically to below 100 U/L for either ALT or AST. Muscle sources of the enzymes, such as intense exercise, are unrelated to liver function and can markedly increase AST and ALT.
435:"Common reference intervals for aspartate aminotransferase (AST), alanine aminotransferase (ALT) and g-glutamyl transferase (GGT) in serum: results from an IFCC multicenter study"
1615:
1053:
922:
Raurich JM, Pérez O, Llompart-Pou JA, Ibáñez J, Ayestarán I, Pérez-Bárcena J (July 2009). "Incidence and outcome of ischemic hepatitis complicating septic shock".
161:
for liver injury, meaning that they are likely to be present if there is injury. However, they may also be elevated in other conditions such as thyroid disorders,
1046:
298:: Levels fluctuate; the AST and ALT may be normal, though most patients have mild to moderate elevations (approximately twice the URL); with
1039:
126:
to synthesize and break down amino acids and to convert energy storage molecules. The concentrations of these transaminases in the
658:
207:
When the AST is higher than ALT, a muscle source of these enzymes should be considered. For example, muscle inflammation due to
17:
377:
168:
ALT is usually found only in the liver. AST is most commonly found in the liver, but also in significant amounts in heart (
1413:
1351:
244:
183:, although they have been replaced by newer enzyme and protein tests that are more specific for cardiac damage.
216:
1552:
1308:
630:
Oh, RC; Hustead, TR (1 November 2011). "Causes and evaluation of mildly elevated liver transaminase levels".
236:
1244:
1206:
130:(the non-cellular portion of blood) are normally low. However, if the liver is damaged, the liver cell (
1585:
1136:
1286:
288:: Wide variability, typically normal to less than twice the URL, rarely more than 10 times the URL
1281:
1149:
1114:
201:
102:
1401:
1296:
1239:
1201:
146:
77:
55:
1341:
1318:
1303:
1234:
275:
180:
1539:
1396:
1384:
1361:
1291:
1216:
1084:
816:
Henrion, J.; Schapira, M.; Luwaert, R.; Colin, L.; Delannoy, A.; Heller, F. R. (Nov 2003).
142:
73:
47:
215:
when other sources may influence AST and/or ALT, because they do not reliably reflect the
8:
1610:
1377:
1372:
1269:
1109:
1003:
158:
211:
may cause AST>ALT. This is a good reminder that AST and ALT are not good measures of
1173:
1094:
947:
904:
847:
689:
607:
582:
558:
533:
509:
484:
462:
410:
393:
269:
1008:
834:
817:
367:
1479:
1458:
1126:
1121:
1014:
939:
935:
896:
839:
798:
794:
759:
728:
720:
681:
639:
612:
563:
545:
514:
500:
485:"Muscular exercise can cause highly pathological liver function tests in healthy men"
454:
415:
373:
350:
293:
283:
1031:
951:
851:
693:
466:
138:
becomes more permeable and some of the enzymes leak out into the blood circulation.
1569:
1226:
931:
908:
886:
878:
829:
790:
673:
602:
594:
553:
504:
496:
446:
405:
1423:
1562:
1557:
253:
228:
208:
197:
173:
39:
1428:
708:
338:
1470:
1326:
1099:
1089:
1019:
257:
212:
169:
162:
993:
1604:
1513:
1492:
1406:
1331:
1264:
724:
549:
312:
135:
89:
866:
818:"Hypoxic hepatitis: clinical and hemodynamic study in 142 consecutive cases"
434:
1518:
1487:
1390:
1079:
943:
900:
843:
778:
747:
732:
685:
643:
616:
583:"Misconception: You Can't Have Liver Disease With Normal Liver Chemistries"
567:
518:
458:
354:
299:
127:
123:
51:
802:
763:
450:
419:
1336:
1276:
1211:
1164:
1159:
1154:
1071:
891:
779:"Ischemic hepatitis: clinical and laboratory observations of 34 patients"
777:
Fuchs, S.; Bogomolski-Yahalom, V.; Paltiel, O.; Ackerman, Z. (Apr 1998).
677:
976:
1256:
1196:
1183:
1104:
1063:
709:"Mildly Elevated Liver Transaminase Levels in the Asymptomatic Patient"
339:"Mildly Elevated Liver Transaminase Levels in the Asymptomatic Patient"
131:
882:
776:
1418:
1346:
1144:
106:
98:
94:
80:(AST), may be an indicator of liver dysfunction. Other terms include
598:
1508:
1440:
1191:
368:
Maddrey, Willis C.; Schiff, Eugene R.; Sorrell, Michael F. (2007).
261:
65:
659:"ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries"
372:. Hagerstwon, MD: Lippincott Williams & Wilkins. p. 924.
1448:
1453:
988:
921:
119:
815:
394:"Transaminasemia: semantic confusion of a clinical dilemma"
534:"What is the Real Function of the Liver 'Function' Tests?"
657:
Kwo, Paul Y.; Cohen, Stanley M.; Lim, Joseph K. (2017).
222:
1061:
581:
Lominadze, Zurabi; Kallwitz, Eric R. (October 2018).
274:: AST and ALT > 50 times the URL (in addition the
966:
240:: AST > 8 times the URL; ALT > 5 times the URL
196:
transaminases suggests severe liver damage, such as
1616:
Abnormal clinical and laboratory findings for blood
179:Measurement of ALT and AST were used in diagnosing
580:
1602:
478:
476:
332:
330:
328:
1047:
473:
915:
141:The two transaminases commonly measured are
745:
656:
532:Hall, Philip; Cash, Johnny (January 2012).
426:
325:
149:(AST). These levels previously were called
1054:
1040:
864:
482:
386:
336:
38:
890:
833:
629:
606:
557:
508:
409:
155:serum glutamate-oxaloacetate transaminase
531:
489:British Journal of Clinical Pharmacology
432:
748:"Ischemic hepatitis: widening horizons"
706:
302:, levels are more than 10 times the URL
14:
1603:
650:
1035:
746:Gitlin, N.; Serio, K. M. (Jul 1992).
361:
151:serum glutamate-pyruvate transaminase
865:Lok AS, McMahon BJ (February 2007).
483:Pettersson, J.; et al. (2007).
190:
1352:Glycogen phosphorylase isoenzyme BB
265:: AST and ALT > 25 times the URL
223:Magnitude of AST and ALT elevations
24:
433:Ceriotti, F.; et al. (2010).
248:: AST and ALT > 4 times the URL
113:
25:
1627:
962:
835:10.1097/01.md.0000101573.54295.bd
936:10.1111/j.1872-034X.2009.00501.x
795:10.1097/00004836-199804000-00007
501:10.1111/j.1365-2125.2007.03001.x
245:Nonalcoholic fatty liver disease
858:
809:
770:
739:
707:Giboney, Paul T. (2005-03-15).
700:
623:
574:
525:
370:Schiff's diseases of the liver
217:synthetic ability of the liver
13:
1:
1309:Comprehensive metabolic panel
318:
237:Alcoholic fatty liver disease
72:, commonly the transaminases
157:(SGOT). Elevated levels are
7:
1245:Thyroid-stimulating hormone
1207:Total iron-binding capacity
306:
278:is often markedly elevated)
10:
1632:
1586:Elevated alpha-fetoprotein
538:The Ulster Medical Journal
1578:
1538:
1531:
1501:
1478:
1469:
1439:
1360:
1317:
1255:
1225:
1182:
1135:
1070:
970:
713:American Family Physician
632:American Family Physician
337:Giboney PT (March 2005).
46:
37:
32:
165:, and muscle disorders.
1115:BUN-to-creatinine ratio
258:toxin-related hepatitis
202:alcoholic liver disease
103:fulminant liver failure
1548:Elevated transaminases
1240:Thyroid function tests
1202:Transferrin saturation
1062:Clinical biochemistry
587:Clinical Liver Disease
404:(6): 45–7. June 1971.
147:aspartate transaminase
78:aspartate transaminase
70:elevated transaminases
56:Aspartate transaminase
33:Elevated transaminases
18:Elevated liver enzymes
1342:Lactate dehydrogenase
1304:Basic metabolic panel
1235:ACTH stimulation test
867:"Chronic hepatitis B"
451:10.1515/CCLM.2010.315
276:lactate dehydrogenase
229:upper reference limit
1362:Liver function tests
1217:Transferrin receptor
822:Medicine (Baltimore)
783:J Clin Gastroenterol
678:10.1038/ajg.2016.517
666:Am. J. Gastroenterol
270:Ischemic hepatopathy
143:alanine transaminase
74:alanine transaminase
48:Alanine transaminase
1378:Serum total protein
1373:Human serum albumin
924:Hepatology Research
1150:Arterial blood gas
752:Am J Gastroenterol
68:, the presence of
50:is one of the two
1598:
1597:
1594:
1593:
1527:
1526:
1480:Blood sugar level
1459:Pancreatic lipase
1297:Total cholesterol
1127:Serum osmolal gap
1122:Plasma osmolality
1029:
1028:
883:10.1002/hep.21513
445:(11): 1593–2101.
439:Clin Chem Lab Med
379:978-0-7817-6040-9
294:hepatitis B virus
284:hepatitis C virus
191:Role in diagnosis
62:
61:
27:Medical condition
16:(Redirected from
1623:
1570:Hyperproteinemia
1536:
1535:
1476:
1475:
1056:
1049:
1042:
1033:
1032:
968:
967:
956:
955:
919:
913:
912:
894:
862:
856:
855:
837:
813:
807:
806:
774:
768:
767:
743:
737:
736:
719:(6): 1105–1110.
704:
698:
697:
663:
654:
648:
647:
627:
621:
620:
610:
578:
572:
571:
561:
529:
523:
522:
512:
480:
471:
470:
430:
424:
423:
413:
390:
384:
383:
365:
359:
358:
343:Am Fam Physician
334:
101:of the liver or
42:
30:
29:
21:
1631:
1630:
1626:
1625:
1624:
1622:
1621:
1620:
1601:
1600:
1599:
1590:
1574:
1563:Hypoalbuminemia
1558:Hypoproteinemia
1523:
1497:
1471:Small molecules
1465:
1435:
1356:
1313:
1251:
1221:
1178:
1168:
1131:
1066:
1060:
1030:
1025:
1024:
979:
965:
960:
959:
920:
916:
863:
859:
814:
810:
775:
771:
744:
740:
705:
701:
661:
655:
651:
628:
624:
599:10.1002/cld.742
579:
575:
530:
526:
481:
474:
431:
427:
392:
391:
387:
380:
366:
362:
335:
326:
321:
309:
254:viral hepatitis
225:
209:dermatomyositis
198:viral hepatitis
193:
174:skeletal muscle
116:
114:Pathophysiology
82:transaminasemia
28:
23:
22:
15:
12:
11:
5:
1629:
1619:
1618:
1613:
1596:
1595:
1592:
1591:
1589:
1588:
1582:
1580:
1576:
1575:
1573:
1572:
1567:
1566:
1565:
1555:
1550:
1544:
1542:
1533:
1529:
1528:
1525:
1524:
1522:
1521:
1516:
1511:
1505:
1503:
1499:
1498:
1496:
1495:
1490:
1484:
1482:
1473:
1467:
1466:
1464:
1463:
1462:
1461:
1451:
1445:
1443:
1437:
1436:
1434:
1433:
1432:
1431:
1426:
1416:
1411:
1410:
1409:
1404:
1399:
1387:
1382:
1381:
1380:
1375:
1366:
1364:
1358:
1357:
1355:
1354:
1349:
1344:
1339:
1334:
1329:
1327:Cardiac marker
1323:
1321:
1319:Cardiovascular
1315:
1314:
1312:
1311:
1306:
1301:
1300:
1299:
1294:
1289:
1284:
1274:
1273:
1272:
1270:Hemoglobin A1c
1261:
1259:
1253:
1252:
1250:
1249:
1248:
1247:
1237:
1231:
1229:
1223:
1222:
1220:
1219:
1214:
1209:
1204:
1199:
1194:
1188:
1186:
1180:
1179:
1177:
1176:
1171:
1166:
1162:
1157:
1152:
1147:
1141:
1139:
1133:
1132:
1130:
1129:
1124:
1119:
1118:
1117:
1112:
1107:
1100:Renal function
1097:
1092:
1087:
1082:
1076:
1074:
1068:
1067:
1059:
1058:
1051:
1044:
1036:
1027:
1026:
1023:
1022:
1011:
996:
980:
975:
974:
972:
971:Classification
964:
963:External links
961:
958:
957:
914:
857:
828:(6): 392–406.
808:
769:
738:
699:
649:
622:
573:
524:
495:(2): 253–259.
472:
425:
385:
378:
360:
349:(6): 1105–10.
323:
322:
320:
317:
316:
315:
308:
305:
304:
303:
289:
279:
266:
249:
241:
224:
221:
213:liver function
192:
189:
163:celiac disease
115:
112:
60:
59:
58:is the other).
44:
43:
35:
34:
26:
9:
6:
4:
3:
2:
1628:
1617:
1614:
1612:
1609:
1608:
1606:
1587:
1584:
1583:
1581:
1577:
1571:
1568:
1564:
1561:
1560:
1559:
1556:
1554:
1551:
1549:
1546:
1545:
1543:
1541:
1537:
1534:
1530:
1520:
1517:
1515:
1514:Hyperuricemia
1512:
1510:
1507:
1506:
1504:
1500:
1494:
1493:Hyperglycemia
1491:
1489:
1486:
1485:
1483:
1481:
1477:
1474:
1472:
1468:
1460:
1457:
1456:
1455:
1452:
1450:
1447:
1446:
1444:
1442:
1438:
1430:
1427:
1425:
1422:
1421:
1420:
1417:
1415:
1412:
1408:
1407:AST/ALT ratio
1405:
1403:
1400:
1398:
1395:
1394:
1393:
1392:
1391:transaminases
1388:
1386:
1383:
1379:
1376:
1374:
1371:
1370:
1368:
1367:
1365:
1363:
1359:
1353:
1350:
1348:
1345:
1343:
1340:
1338:
1335:
1333:
1332:Troponin test
1330:
1328:
1325:
1324:
1322:
1320:
1316:
1310:
1307:
1305:
1302:
1298:
1295:
1293:
1292:Triglycerides
1290:
1288:
1285:
1283:
1280:
1279:
1278:
1275:
1271:
1268:
1267:
1266:
1265:Blood glucose
1263:
1262:
1260:
1258:
1254:
1246:
1243:
1242:
1241:
1238:
1236:
1233:
1232:
1230:
1228:
1224:
1218:
1215:
1213:
1210:
1208:
1205:
1203:
1200:
1198:
1195:
1193:
1190:
1189:
1187:
1185:
1181:
1175:
1172:
1170:
1163:
1161:
1158:
1156:
1153:
1151:
1148:
1146:
1143:
1142:
1140:
1138:
1134:
1128:
1125:
1123:
1120:
1116:
1113:
1111:
1108:
1106:
1103:
1102:
1101:
1098:
1096:
1093:
1091:
1088:
1086:
1083:
1081:
1078:
1077:
1075:
1073:
1069:
1065:
1057:
1052:
1050:
1045:
1043:
1038:
1037:
1034:
1021:
1017:
1016:
1012:
1010:
1006:
1005:
1001:
997:
995:
991:
990:
986:
982:
981:
978:
973:
969:
953:
949:
945:
941:
937:
933:
929:
925:
918:
910:
906:
902:
898:
893:
892:2027.42/55941
888:
884:
880:
877:(2): 507–39.
876:
872:
868:
861:
853:
849:
845:
841:
836:
831:
827:
823:
819:
812:
804:
800:
796:
792:
788:
784:
780:
773:
765:
761:
757:
753:
749:
742:
734:
730:
726:
722:
718:
714:
710:
703:
695:
691:
687:
683:
679:
675:
671:
667:
660:
653:
645:
641:
638:(9): 1003–8.
637:
633:
626:
618:
614:
609:
604:
600:
596:
592:
588:
584:
577:
569:
565:
560:
555:
551:
547:
543:
539:
535:
528:
520:
516:
511:
506:
502:
498:
494:
490:
486:
479:
477:
468:
464:
460:
456:
452:
448:
444:
440:
436:
429:
421:
417:
412:
407:
403:
399:
395:
389:
381:
375:
371:
364:
356:
352:
348:
344:
340:
333:
331:
329:
324:
314:
313:AST/ALT ratio
311:
310:
301:
300:exacerbations
297:
295:
290:
287:
285:
280:
277:
273:
272:(shock liver)
271:
267:
264:
263:
259:
255:
250:
247:
246:
242:
239:
238:
234:
233:
232:
230:
220:
218:
214:
210:
205:
203:
199:
188:
184:
182:
181:heart attacks
177:
175:
171:
166:
164:
160:
156:
152:
148:
144:
139:
137:
133:
129:
125:
124:transaminases
121:
111:
108:
105:secondary to
104:
100:
96:
92:
91:
90:liver enzymes
87:
83:
79:
75:
71:
67:
57:
53:
52:transaminases
49:
45:
41:
36:
31:
19:
1553:Elevated ALP
1547:
1519:Hypouricemia
1488:Hypoglycemia
1424:Unconjugated
1389:
1072:Electrolytes
1013:
998:
983:
930:(7): 700–5.
927:
923:
917:
874:
870:
860:
825:
821:
811:
789:(3): 183–6.
786:
782:
772:
758:(7): 831–6.
755:
751:
741:
716:
712:
702:
672:(1): 18–35.
669:
665:
652:
635:
631:
625:
593:(4): 96–99.
590:
586:
576:
544:(1): 30–36.
541:
537:
527:
492:
488:
442:
438:
428:
401:
397:
388:
369:
363:
346:
342:
291:
281:
268:
251:
243:
235:
226:
206:
194:
185:
178:
167:
154:
150:
140:
117:
88:
85:
81:
69:
63:
1502:Nitrogenous
1337:CPK-MB test
1277:Lipid panel
1212:Transferrin
1160:Bicarbonate
1155:Base excess
1064:blood tests
153:(SGPT) and
1611:Hepatology
1605:Categories
1429:Conjugated
1257:Metabolism
1197:Serum iron
1184:Iron tests
1105:Creatinine
1015:DiseasesDB
871:Hepatology
319:References
145:(ALT) and
132:hepatocyte
76:(ALT) and
54:measured (
1419:Bilirubin
1369:Proteins
1347:Myoglobin
1145:Anion gap
1137:Acid-base
1085:Potassium
725:0002-838X
550:0041-6193
398:Calif Med
296:infection
286:infection
159:sensitive
107:hepatitis
99:Cirrhosis
95:isoniazid
1532:Proteins
1509:Azotemia
1441:Pancreas
1227:Hormones
1192:Ferritin
1090:Chloride
952:20312771
944:19473435
901:17256718
852:27754941
844:14663289
733:15791889
694:23788795
686:27995906
644:22046940
617:30988921
568:23536736
519:17764474
467:21929466
459:21034260
355:15791889
307:See also
292:Chronic
282:Chronic
262:jaundice
136:membrane
110:nature.
86:elevated
66:medicine
1449:Amylase
1174:Lactate
1169:content
1095:Calcium
909:8713169
803:9600366
764:1615936
608:6385914
559:3609680
510:2291230
420:5578107
411:1501958
170:cardiac
1454:Lipase
1080:Sodium
950:
942:
907:
899:
850:
842:
801:
762:
731:
723:
692:
684:
642:
615:
605:
566:
556:
548:
517:
507:
465:
457:
418:
408:
376:
353:
252:Acute
172:) and
84:, and
1579:Other
1020:14820
1009:790.4
994:R74.0
948:S2CID
905:S2CID
848:S2CID
690:S2CID
662:(PDF)
463:S2CID
260:with
128:serum
120:liver
1110:Urea
1004:9-CM
940:PMID
897:PMID
840:PMID
799:PMID
760:PMID
729:PMID
721:ISSN
682:PMID
640:PMID
613:PMID
564:PMID
546:ISSN
515:PMID
455:PMID
416:PMID
374:ISBN
351:PMID
122:has
118:The
1540:LFT
1414:GGT
1402:AST
1397:ALT
1385:ALP
1287:HDL
1282:LDL
1000:ICD
985:ICD
932:doi
887:hdl
879:doi
830:doi
791:doi
674:doi
670:112
603:PMC
595:doi
554:PMC
505:PMC
497:doi
447:doi
406:PMC
402:114
256:or
64:In
1607::
1165:CO
1018::
1007::
992::
989:10
946:.
938:.
928:39
926:.
903:.
895:.
885:.
875:45
873:.
869:.
846:.
838:.
826:82
824:.
820:.
797:.
787:26
785:.
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756:87
754:.
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727:.
717:71
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688:.
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441:.
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347:71
345:.
341:.
327:^
204:.
176:.
134:)
1167:2
1055:e
1048:t
1041:v
1002:-
987:-
977:D
954:.
934::
911:.
889::
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854:.
832::
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