29:
82:(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 μkal/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
98:
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
184:
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
175:
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.
988:
973:
220:" (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 μkal/L) for both AST and ALT. While values vary between individuals, the following are typical AST and ALT patterns:
208:, 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.
1604:
216:
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 "
1042:
189:, 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
86:
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.
424:"Common reference intervals for aspartate aminotransferase (AST), alanine aminotransferase (ALT) and g-glutamyl transferase (GGT) in serum: results from an IFCC multicenter study"
1035:
911:
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".
150:
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,
1028:
366:
287:: Levels fluctuate; the AST and ALT may be normal, though most patients have mild to moderate elevations (approximately twice the URL); with
1340:
115:
to synthesize and break down amino acids and to convert energy storage molecules. The concentrations of these transaminases in the
647:
233:
196:
When the AST is higher than ALT, a muscle source of these enzymes should be considered. For example, muscle inflammation due to
205:
157:
ALT is usually found only in the liver. AST is most commonly found in the liver, but also in significant amounts in heart (
1541:
1297:
225:
1233:
1195:
1574:
1125:
1402:
172:, although they have been replaced by newer enzyme and protein tests that are more specific for cardiac damage.
1275:
619:
Oh, RC; Hustead, TR (1 November 2011). "Causes and evaluation of mildly elevated liver transaminase levels".
1270:
1138:
1103:
190:
91:
1390:
1228:
1190:
135:
66:
44:
1330:
1307:
1292:
1223:
264:
169:
119:(the non-cellular portion of blood) are normally low. However, if the liver is damaged, the liver cell (
1528:
1385:
1373:
1350:
1205:
1073:
131:
62:
36:
1599:
1366:
1361:
1258:
1098:
992:
147:
277:: Wide variability, typically normal to less than twice the URL, rarely more than 10 times the URL
28:
1083:
936:
893:
836:
678:
451:
258:
1468:
1447:
1115:
1110:
1003:
928:
885:
828:
787:
748:
717:
709:
670:
628:
601:
552:
534:
503:
443:
404:
362:
339:
282:
272:
1558:
1215:
920:
875:
867:
818:
779:
662:
591:
583:
542:
493:
485:
435:
394:
805:
Henrion, J.; Schapira, M.; Luwaert, R.; Colin, L.; Delannoy, A.; Heller, F. R. (Nov 2003).
1551:
1546:
242:
217:
204:
when other sources may influence AST and/or ALT, because they do not reliably reflect the
197:
186:
162:
200:
may cause AST>ALT. This is a good reminder that AST and ALT are not good measures of
1459:
1315:
1088:
1078:
596:
571:
547:
522:
498:
473:
399:
382:
246:
201:
158:
151:
997:
823:
806:
1593:
1502:
1481:
1395:
1320:
1253:
924:
783:
489:
474:"Muscular exercise can cause highly pathological liver function tests in healthy men"
301:
124:
78:
1020:
940:
840:
682:
455:
127:
becomes more permeable and some of the enzymes leak out into the blood circulation.
1507:
1476:
1379:
1280:
1068:
897:
288:
116:
112:
40:
1325:
1285:
1265:
1200:
1162:
1153:
1148:
1143:
1060:
697:
327:
1008:
1245:
1185:
1172:
1093:
1052:
982:
120:
713:
538:
1417:
1412:
1407:
1335:
1133:
855:
807:"Hypoxic hepatitis: clinical and hemodynamic study in 142 consecutive cases"
423:
95:
87:
83:
932:
889:
832:
767:
736:
721:
674:
632:
605:
572:"Misconception: You Can't Have Liver Disease With Normal Liver Chemistries"
556:
507:
447:
343:
791:
752:
439:
408:
1497:
1429:
1180:
880:
768:"Ischemic hepatitis: clinical and laboratory observations of 34 patients"
766:
Fuchs, S.; Bogomolski-Yahalom, V.; Paltiel, O.; Ackerman, Z. (Apr 1998).
666:
250:
54:
965:
1437:
698:"Mildly Elevated Liver Transaminase Levels in the Asymptomatic Patient"
328:"Mildly Elevated Liver Transaminase Levels in the Asymptomatic Patient"
871:
1442:
977:
69:(AST), may be an indicator of liver dysfunction. Other terms include
587:
357:
Maddrey, Willis C.; Schiff, Eugene R.; Sorrell, Michael F. (2007).
648:"ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries"
361:. Hagerstwon, MD: Lippincott Williams & Wilkins. p. 924.
108:
1024:
383:"Transaminasemia: semantic confusion of a clinical dilemma"
523:"What is the Real Function of the Liver 'Function' Tests?"
646:
Kwo, Paul Y.; Cohen, Stanley M.; Lim, Joseph K. (2017).
570:
Lominadze, Zurabi; Kallwitz, Eric R. (October 2018).
263:: AST and ALT > 50 times the URL (in addition the
955:
229:: AST > 8 times the URL; ALT > 5 times the URL
185:
transaminases suggests severe liver damage, such as
1605:
Abnormal clinical and laboratory findings for blood
1567:
1527:
1520:
1490:
1467:
1458:
1428:
1349:
1306:
1244:
1214:
1171:
1124:
1059:
959:
168:Measurement of ALT and AST were used in diagnosing
21:
467:
465:
321:
319:
317:
1036:
8:
130:The two transaminases commonly measured are
521:Hall, Philip; Cash, Johnny (January 2012).
138:(AST). These levels previously were called
1524:
1464:
1043:
1029:
1021:
956:
27:
18:
879:
822:
595:
546:
497:
398:
144:serum glutamate-oxaloacetate transaminase
478:British Journal of Clinical Pharmacology
737:"Ischemic hepatitis: widening horizons"
313:
291:, levels are more than 10 times the URL
735:Gitlin, N.; Serio, K. M. (Jul 1992).
140:serum glutamate-pyruvate transaminase
7:
854:Lok AS, McMahon BJ (February 2007).
472:Pettersson, J.; et al. (2007).
1341:Glycogen phosphorylase isoenzyme BB
254:: AST and ALT > 25 times the URL
212:Magnitude of AST and ALT elevations
422:Ceriotti, F.; et al. (2010).
237:: AST and ALT > 4 times the URL
14:
824:10.1097/01.md.0000101573.54295.bd
925:10.1111/j.1872-034X.2009.00501.x
784:10.1097/00004836-199804000-00007
490:10.1111/j.1365-2125.2007.03001.x
234:Nonalcoholic fatty liver disease
696:Giboney, Paul T. (2005-03-15).
359:Schiff's diseases of the liver
206:synthetic ability of the liver
1:
1298:Comprehensive metabolic panel
226:Alcoholic fatty liver disease
61:, commonly the transaminases
146:(SGOT). Elevated levels are
1234:Thyroid-stimulating hormone
1196:Total iron-binding capacity
267:is often markedly elevated)
1621:
1575:Elevated alpha-fetoprotein
527:The Ulster Medical Journal
702:American Family Physician
621:American Family Physician
326:Giboney PT (March 2005).
35:
26:
154:, and muscle disorders.
1104:BUN-to-creatinine ratio
247:toxin-related hepatitis
191:alcoholic liver disease
92:fulminant liver failure
1537:Elevated transaminases
1229:Thyroid function tests
1191:Transferrin saturation
1051:Clinical biochemistry
576:Clinical Liver Disease
393:(6): 45–7. June 1971.
136:aspartate transaminase
67:aspartate transaminase
59:elevated transaminases
45:Aspartate transaminase
22:Elevated transaminases
1331:Lactate dehydrogenase
1293:Basic metabolic panel
1224:ACTH stimulation test
856:"Chronic hepatitis B"
440:10.1515/CCLM.2010.315
265:lactate dehydrogenase
218:upper reference limit
1351:Liver function tests
1206:Transferrin receptor
811:Medicine (Baltimore)
772:J Clin Gastroenterol
667:10.1038/ajg.2016.517
655:Am. J. Gastroenterol
259:Ischemic hepatopathy
132:alanine transaminase
63:alanine transaminase
37:Alanine transaminase
1367:Serum total protein
1362:Human serum albumin
913:Hepatology Research
1139:Arterial blood gas
741:Am J Gastroenterol
57:, the presence of
39:is one of the two
1587:
1586:
1583:
1582:
1516:
1515:
1469:Blood sugar level
1448:Pancreatic lipase
1286:Total cholesterol
1116:Serum osmolal gap
1111:Plasma osmolality
1018:
1017:
872:10.1002/hep.21513
434:(11): 1593–2101.
428:Clin Chem Lab Med
368:978-0-7817-6040-9
283:hepatitis B virus
273:hepatitis C virus
180:Role in diagnosis
51:
50:
16:Medical condition
1612:
1559:Hyperproteinemia
1525:
1465:
1045:
1038:
1031:
1022:
957:
945:
944:
908:
902:
901:
883:
851:
845:
844:
826:
802:
796:
795:
763:
757:
756:
732:
726:
725:
708:(6): 1105–1110.
693:
687:
686:
652:
643:
637:
636:
616:
610:
609:
599:
567:
561:
560:
550:
518:
512:
511:
501:
469:
460:
459:
419:
413:
412:
402:
379:
373:
372:
354:
348:
347:
332:Am Fam Physician
323:
90:of the liver or
31:
19:
1620:
1619:
1615:
1614:
1613:
1611:
1610:
1609:
1590:
1589:
1588:
1579:
1563:
1552:Hypoalbuminemia
1547:Hypoproteinemia
1512:
1486:
1460:Small molecules
1454:
1424:
1345:
1302:
1240:
1210:
1167:
1157:
1120:
1055:
1049:
1019:
1014:
1013:
968:
954:
949:
948:
910:
909:
905:
853:
852:
848:
804:
803:
799:
765:
764:
760:
734:
733:
729:
695:
694:
690:
650:
645:
644:
640:
618:
617:
613:
588:10.1002/cld.742
569:
568:
564:
520:
519:
515:
471:
470:
463:
421:
420:
416:
381:
380:
376:
369:
356:
355:
351:
325:
324:
315:
310:
298:
243:viral hepatitis
214:
198:dermatomyositis
187:viral hepatitis
182:
163:skeletal muscle
105:
103:Pathophysiology
71:transaminasemia
17:
12:
11:
5:
1618:
1616:
1608:
1607:
1602:
1592:
1591:
1585:
1584:
1581:
1580:
1578:
1577:
1571:
1569:
1565:
1564:
1562:
1561:
1556:
1555:
1554:
1544:
1539:
1533:
1531:
1522:
1518:
1517:
1514:
1513:
1511:
1510:
1505:
1500:
1494:
1492:
1488:
1487:
1485:
1484:
1479:
1473:
1471:
1462:
1456:
1455:
1453:
1452:
1451:
1450:
1440:
1434:
1432:
1426:
1425:
1423:
1422:
1421:
1420:
1415:
1405:
1400:
1399:
1398:
1393:
1388:
1376:
1371:
1370:
1369:
1364:
1355:
1353:
1347:
1346:
1344:
1343:
1338:
1333:
1328:
1323:
1318:
1316:Cardiac marker
1312:
1310:
1308:Cardiovascular
1304:
1303:
1301:
1300:
1295:
1290:
1289:
1288:
1283:
1278:
1273:
1263:
1262:
1261:
1259:Hemoglobin A1c
1250:
1248:
1242:
1241:
1239:
1238:
1237:
1236:
1226:
1220:
1218:
1212:
1211:
1209:
1208:
1203:
1198:
1193:
1188:
1183:
1177:
1175:
1169:
1168:
1166:
1165:
1160:
1155:
1151:
1146:
1141:
1136:
1130:
1128:
1122:
1121:
1119:
1118:
1113:
1108:
1107:
1106:
1101:
1096:
1089:Renal function
1086:
1081:
1076:
1071:
1065:
1063:
1057:
1056:
1050:
1048:
1047:
1040:
1033:
1025:
1016:
1015:
1012:
1011:
1000:
985:
969:
964:
963:
961:
960:Classification
953:
952:External links
950:
947:
946:
903:
846:
817:(6): 392–406.
797:
758:
727:
688:
638:
611:
562:
513:
484:(2): 253–259.
461:
414:
374:
367:
349:
338:(6): 1105–10.
312:
311:
309:
306:
305:
304:
297:
294:
293:
292:
278:
268:
255:
238:
230:
213:
210:
202:liver function
181:
178:
152:celiac disease
104:
101:
49:
48:
47:is the other).
33:
32:
24:
23:
15:
13:
10:
9:
6:
4:
3:
2:
1617:
1606:
1603:
1601:
1598:
1597:
1595:
1576:
1573:
1572:
1570:
1566:
1560:
1557:
1553:
1550:
1549:
1548:
1545:
1543:
1540:
1538:
1535:
1534:
1532:
1530:
1526:
1523:
1519:
1509:
1506:
1504:
1503:Hyperuricemia
1501:
1499:
1496:
1495:
1493:
1489:
1483:
1482:Hyperglycemia
1480:
1478:
1475:
1474:
1472:
1470:
1466:
1463:
1461:
1457:
1449:
1446:
1445:
1444:
1441:
1439:
1436:
1435:
1433:
1431:
1427:
1419:
1416:
1414:
1411:
1410:
1409:
1406:
1404:
1401:
1397:
1396:AST/ALT ratio
1394:
1392:
1389:
1387:
1384:
1383:
1382:
1381:
1380:transaminases
1377:
1375:
1372:
1368:
1365:
1363:
1360:
1359:
1357:
1356:
1354:
1352:
1348:
1342:
1339:
1337:
1334:
1332:
1329:
1327:
1324:
1322:
1321:Troponin test
1319:
1317:
1314:
1313:
1311:
1309:
1305:
1299:
1296:
1294:
1291:
1287:
1284:
1282:
1281:Triglycerides
1279:
1277:
1274:
1272:
1269:
1268:
1267:
1264:
1260:
1257:
1256:
1255:
1254:Blood glucose
1252:
1251:
1249:
1247:
1243:
1235:
1232:
1231:
1230:
1227:
1225:
1222:
1221:
1219:
1217:
1213:
1207:
1204:
1202:
1199:
1197:
1194:
1192:
1189:
1187:
1184:
1182:
1179:
1178:
1176:
1174:
1170:
1164:
1161:
1159:
1152:
1150:
1147:
1145:
1142:
1140:
1137:
1135:
1132:
1131:
1129:
1127:
1123:
1117:
1114:
1112:
1109:
1105:
1102:
1100:
1097:
1095:
1092:
1091:
1090:
1087:
1085:
1082:
1080:
1077:
1075:
1072:
1070:
1067:
1066:
1064:
1062:
1058:
1054:
1046:
1041:
1039:
1034:
1032:
1027:
1026:
1023:
1010:
1006:
1005:
1001:
999:
995:
994:
990:
986:
984:
980:
979:
975:
971:
970:
967:
962:
958:
951:
942:
938:
934:
930:
926:
922:
918:
914:
907:
904:
899:
895:
891:
887:
882:
881:2027.42/55941
877:
873:
869:
866:(2): 507–39.
865:
861:
857:
850:
847:
842:
838:
834:
830:
825:
820:
816:
812:
808:
801:
798:
793:
789:
785:
781:
777:
773:
769:
762:
759:
754:
750:
746:
742:
738:
731:
728:
723:
719:
715:
711:
707:
703:
699:
692:
689:
684:
680:
676:
672:
668:
664:
660:
656:
649:
642:
639:
634:
630:
627:(9): 1003–8.
626:
622:
615:
612:
607:
603:
598:
593:
589:
585:
581:
577:
573:
566:
563:
558:
554:
549:
544:
540:
536:
532:
528:
524:
517:
514:
509:
505:
500:
495:
491:
487:
483:
479:
475:
468:
466:
462:
457:
453:
449:
445:
441:
437:
433:
429:
425:
418:
415:
410:
406:
401:
396:
392:
388:
384:
378:
375:
370:
364:
360:
353:
350:
345:
341:
337:
333:
329:
322:
320:
318:
314:
307:
303:
302:AST/ALT ratio
300:
299:
295:
290:
289:exacerbations
286:
284:
279:
276:
274:
269:
266:
262:
261:(shock liver)
260:
256:
253:
252:
248:
244:
239:
236:
235:
231:
228:
227:
223:
222:
221:
219:
211:
209:
207:
203:
199:
194:
192:
188:
179:
177:
173:
171:
170:heart attacks
166:
164:
160:
155:
153:
149:
145:
141:
137:
133:
128:
126:
122:
118:
114:
113:transaminases
110:
102:
100:
97:
94:secondary to
93:
89:
85:
81:
80:
79:liver enzymes
76:
72:
68:
64:
60:
56:
46:
42:
41:transaminases
38:
34:
30:
25:
20:
1542:Elevated ALP
1536:
1508:Hypouricemia
1477:Hypoglycemia
1413:Unconjugated
1378:
1061:Electrolytes
1002:
987:
972:
919:(7): 700–5.
916:
912:
906:
863:
859:
849:
814:
810:
800:
778:(3): 183–6.
775:
771:
761:
747:(7): 831–6.
744:
740:
730:
705:
701:
691:
661:(1): 18–35.
658:
654:
641:
624:
620:
614:
582:(4): 96–99.
579:
575:
565:
533:(1): 30–36.
530:
526:
516:
481:
477:
431:
427:
417:
390:
386:
377:
358:
352:
335:
331:
280:
270:
257:
240:
232:
224:
215:
195:
183:
174:
167:
156:
143:
139:
129:
106:
77:
74:
70:
58:
52:
1491:Nitrogenous
1326:CPK-MB test
1266:Lipid panel
1201:Transferrin
1149:Bicarbonate
1144:Base excess
1053:blood tests
142:(SGPT) and
1600:Hepatology
1594:Categories
1418:Conjugated
1246:Metabolism
1186:Serum iron
1173:Iron tests
1094:Creatinine
1004:DiseasesDB
860:Hepatology
308:References
134:(ALT) and
121:hepatocyte
65:(ALT) and
43:measured (
1408:Bilirubin
1358:Proteins
1336:Myoglobin
1134:Anion gap
1126:Acid-base
1074:Potassium
714:0002-838X
539:0041-6193
387:Calif Med
285:infection
275:infection
148:sensitive
96:hepatitis
88:Cirrhosis
84:isoniazid
1521:Proteins
1498:Azotemia
1430:Pancreas
1216:Hormones
1181:Ferritin
1079:Chloride
941:20312771
933:19473435
890:17256718
841:27754941
833:14663289
722:15791889
683:23788795
675:27995906
633:22046940
606:30988921
557:23536736
508:17764474
456:21929466
448:21034260
344:15791889
296:See also
281:Chronic
271:Chronic
251:jaundice
125:membrane
99:nature.
75:elevated
55:medicine
1438:Amylase
1163:Lactate
1158:content
1084:Calcium
898:8713169
792:9600366
753:1615936
597:6385914
548:3609680
499:2291230
409:5578107
400:1501958
159:cardiac
1443:Lipase
1069:Sodium
939:
931:
896:
888:
839:
831:
790:
751:
720:
712:
681:
673:
631:
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537:
506:
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454:
446:
407:
397:
365:
342:
241:Acute
161:) and
73:, and
1568:Other
1009:14820
998:790.4
983:R74.0
937:S2CID
894:S2CID
837:S2CID
679:S2CID
651:(PDF)
452:S2CID
249:with
117:serum
109:liver
1099:Urea
993:9-CM
929:PMID
886:PMID
829:PMID
788:PMID
749:PMID
718:PMID
710:ISSN
671:PMID
629:PMID
602:PMID
553:PMID
535:ISSN
504:PMID
444:PMID
405:PMID
363:ISBN
340:PMID
111:has
107:The
1529:LFT
1403:GGT
1391:AST
1386:ALT
1374:ALP
1276:HDL
1271:LDL
989:ICD
974:ICD
921:doi
876:hdl
868:doi
819:doi
780:doi
663:doi
659:112
592:PMC
584:doi
543:PMC
494:PMC
486:doi
436:doi
395:PMC
391:114
245:or
53:In
1596::
1154:CO
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