AST and ALT liver enzyme tests

[P_Mom]

Hi everyone...

 

Okay, I am throwing this out there because I am interested if any of you see the same pattern. We are in the midst of trying to figure out why my younger son continues to "spit up" in his mouth a lot.....especially shortly after eating. We are seeing a gastro at CHP......he is great, by the way. Motility, spasticity, structure abnormalities, rumination...have been ruled out. GERD is highly questionable because it doesn't really respond to meds (but, maybe we didn't try them long enough)......the regurigitation tastes like his food...not acidic yet...doesn't burn. Anyway, just got some labs back and everything is normal. (I am almost thinking a tic...or something related to PANDAS...as is the gastro, believe it or not)....well, all is normal except I noticed his AST was upper end. (but still normal) I immediately thought the Augmentin...but, don't think so anymore. My levels are rock bottom end of normal...his brother's are low...they have been on the same meds. He is only on 250 mg Aug. daily. So, I went looking back through his labs. 4 years ago when PANDAS hit...he had labs done when he was just a month or so out of bad episode....his AST was 40....can't get any higher without being flagged....ALT was 28. Two years later...after being on Penicillin for a year and Aug. for a year....his AST was was 28 and ALT was 14.....(he was doing really well at this time)...now, a week ago his AST is 32 and ALT is 29. Not a huge difference, but, still in the high range when these enzymes really shouldn't be there...they are normally confined to the liver and , this is the interesting part, the AST is found in the liver and other organs..the brain being one of them. So, right after bad episode it was at its highest......it is released when tissues are damaged, including the brain. Could this be a way to possibly monitor PANDAS? Do PANDAS kids tend to have higher AST? Anybody else see this?

 

That is why I am not thinking meds....his AST was at his highest before he even started antibiotics...he doesn't take Advil, etc.....and the AST was at its lowest after 2 years of antibiotics.....and his PANDAS was in almost complete remission at that time. The AST has crept up a bit this time...just a little, but strep exposure is rampant and he has been a bit touchy lately. So, could the AST be picking up brain inflammation and have nothing to do with the liver

 

 

AST (SGOT) is normally found in a diversity of tissues including liver, heart, muscle, kidney, and brain. It is released into serum when any one of these tissues is damaged. For example, its level in serum rises with heart attacks and with muscle disorders. It is therefore, not a highly specific indicator of liver injury.

 

ALT (SGPT) is, by contrast, normally found largely in the liver. This is not to say that it is exclusively located in liver, but that is where it is most concentrated. It is released into the bloodstream as the result of liver injury. It therefore serves as a fairly specific indicator of liver status.

Edited June 1, 2011 by P.Mom

[JAG10]

Hi Kelly,

 

12/09; AST= 26, ALT= 17. Now I'm looking back 8 months ago; 11/10. dd11's AST= 27, ALT=22. DH has her up in CT today.....so this is all second hand (and of course driving me crazy to be out of the loop), but the ivig nurses said her labs came back elevated and not to give her anymore abx until he speaks with the doctor. Dr. B ordered a CBC and IgG on her, so I'm guessing it is the AST and/or the ALT that are elevated??? Is there anything else on the CBC that would indicate liver stress? I'm having him get a copy of the labs tomorrow.

 

I'll post the current numbers tomorrow, but one thing I can say with certainty is dd's symptoms were definitely WORSE in 12/09 than in 11/10 or now.

 

Jill

[dcmom]

Timely for us. Just got back labs on my two pandas kids-one daughter both numbers within range (alt 33, ast 28), other daughter's ALT is raised at 98, alt normal at 43.

Have not seen doctor yet, not for a couple of weeks. Does anyone know if this is high enough to warrant a phone call about slowing down on abx? She is on 12 mg zoloft daily which is doing nothing- wondering if this is hard on liver (have to look).

 

Both girls are somewhat symptomatic for pandas, tests were done 2 wks ago.

 

I need an assistant

[P_Mom]

Jill...

 

albumin, Alk Phosphatase, Bilirubin, SGOT/AST, SGPT/ALT, total protein, gGtp are the standard liver tests. I could be wrong, but, I do not believe these tests are part of a CBC. My boys liver results were always part of a Hepatic Profile.

 

DcMom.....I would definitely ask about that 98 result. (was that ALT or AST....you put ALT for both)

[tpotter]

My DS has liver enzymes suddenly over 100 and 200 (yes, they are that high.) Been to gastro, and being monitored. Currently doing IV abx, because he was positive for increased ASO, plus spleen enlarged (could that be what's causing the rise in liver enzymes?) I need to get the tests repeated this week, but keep forgetting to call the doctor. Thanks for reminding me.

[philamom]

OMGosh...I didn't realize they could go that high! My daughter LFT's are constantly elevated but never higher than 49.

[JAG10]

Her old one says Complete Metabolic Profile. I thought the lab slip said CBC, but it's probably my mistake bcs most of the tests you mention Kelly, are on there.

 

Does anything besides ABX elevate these tests....besides substance abuse? Any supplements suspected?

[P_Mom]

This is a good link for causes of raised ALT and AST.

 

http://www.medicinenet.com/liver_blood_tests/page3.htm

Edited June 2, 2011 by P.Mom

[kimballot]

Her old one says Complete Metabolic Profile. I thought the lab slip said CBC, but it's probably my mistake bcs most of the tests you mention Kelly, are on there.

 

Does anything besides ABX elevate these tests....besides substance abuse? Any supplements suspected?

 

JAG - I just want to remind everyone that ibuprofen is very hard on the liver and so are anitfungals. These are things we often use with our kids, so please keep an eye on liver functions if you are using these regularly.

[JAG10]

So....if we were trying to aggravate her liver, 2 HD abxs, probiotics, and ibuprofen should do the trick, huh? Does the charcoal/clay make things better or worse? How about the fish oil?

 

Does anyone know, if we back off to the bare minimum the docs determine, how quickly we can expect improvement? How often do we retest? monthly?

[PhillyPA]

I have to check my files for this test. I know that they did a liver panel on my son at Georgetown last month but I forgot to ask for the results. We got back in two weeks so I will make sure to ask them. For the record, my pediatrician told me that augmentin was so benign on the liver. He said not to worry about it effecting the liver. Of course, I still worry but it is good to know that my pediatrician has zero worries about augmentin. Zithromax is another story. That drug can effect the liver.

[P_Mom]

Jill...I have read to discontinue meds for two months...then retest. But, I still wonder if high AST is directly related to the liver. It is not specific for that. ALT...most specific for liver.

 

 

Pam...that is good to hear! Thanks. Meds were not involved in my sons first "high" AST....he was only 4 and on no meds. It just doesn't seem right to me that these kids have higher levels....(unless they are on high doose antibiotics known to aggravate the liver..and/or ibuprophen/acetominophen, etc. That link gives a good list of meds) You'd think their livers are fresh and new......especially at 4 years old and never on any meds, etc.....why these higher enzymes that shouldn't really be there in the first place? Mine are always low, low...bottom range and sometimes off range low.......seems strange to me for the kids to be higher, but I could be on a goose chase.

 

Could it have somethng to do with growth?

Edited June 2, 2011 by P.Mom

[philamom]

My daughter's AST was the hightest (49) last summer after being off abx for eight weeks. But, before the break of abx she was on Flagyl, so not sure if that played a role.

 

fyi- rarely ibuprophen/acet used here.

Edited June 2, 2011 by philamom

[P_Mom]

So, could it be possible that brain inflammation from PANDAS could be playing a role?? (mainly in the AST?)

[philamom]

Ok Pmom...you're in charge of this research . My daughter's AST have been elevated since Nov 2009 (34,49,36,34). Waiting for recent results - last one was taken three months ago. I looked back in her file, and the only time she was ever tested prior to 2009 was during her first major onset of symptoms in 2007, it was also elevated.