ALT Up Again

[Sterlingthecat]

Last year I my alt was 43. I panicked, quit drinking went to the gastro for a full medical work up and had a fibroscan. My alt came down and all of my tests pointed to a normal liver. Six months later I began drinking a drink on Friday, two on Saturday and two on Sunday. I did this for six months and quit drinking completely. My bloods stayed within range until the most recent blood test which showed an alt of 36 which the lab says is 4 points too high for a woman. Given my 20 year history of drinking 3 drinks a day did my weekend of more sensible drinking put me over the safety edge with my liver or is the second alt rise likely to be a fluke since all other bloods are completely normal. How worried should I be?

[AyrshireK]

4 points over is neither here nor there. All sorts can elevate an ALT result (and 4 points over is barely a blip) - anything from a simple infection or even a bit of exercise before your blood test. Doctors worry about blood tests when they are elevated several fold (results into their hundreds or even thousands).

You do need to continue your sobriety if only to stop you continually becoming anxious about the damage you potentially could be doing to your liver.

Katie

[Sterlingthecat in reply to AyrshireK]

You know more about the liver than I do. Isn’t a mild rise in ALT a sign of fibrosis?

[Jay986 in reply to Sterlingthecat]

As Katie said, there’s a lot that could contribute to a small rise, near or slightly above the upper limit. You said you had a full work up, with a Fibroscan, which would be a more definite measure of fibrosis. Don’t forget, it sounds like much of this anxiety is because you know alcohol is bad for your liver, and are/were still drinking. Best to give that up, as it can cause anxiety of its own accord. Enjoy a second chance, don’t jeopardize it

[kensimmons in reply to Sterlingthecat]

I hope you take this in the right way, I am not teasing you or putting you down, I don't do that to people. But I want to just say this in a way that is a comparison that may drive the point home.

I don't know your height or weight (and I am NOT asking), but let's say perfect BMI weight for you was 150. Now imagine you weigh yourself and find out you weigh 155. Would you panic and think "On my goodness, I am overweight, and they say overweight people have a greater chance of having heart attacks and diabetes...am I in big trouble?" No, I don't think you would worry like that.

Being such a miniscule amount over is nothing to worry about. ALT can be affected by hydration for example. If you want to knock a few points down, drink a big glass of water 15 minutes before your test. It just shows how imprecise these tests are.

To switch gears for just a moment, it bothers me that certain things like BMI and ALT and INR and Bilirubin and Sodium (also greatly affected by hydration) affect your MELD score (that is a calculation that determines whether or not you get to be on the waiting list for a transplant that is used in the USA) but tests themselves - the blood numbers - they are so danged imprecise. If you went to the same lab at the same day for a week non-stop and just lived a normal life for that week, your labs would still go up and down by several percentage points throughout that week and that could affect everything from whether you are listed for a transplant, priority for a lab test all the way to what you will pay for a life insurance policy. It's maddening that something that fluctuates all through the week and even day to day is taken as gospel in such important life and death questions. Okay rant over.

Relax and cut back on the alcohol. You should be fine.

Please note I am not a doctor, just a layperson.

Good luck. You'll be fine!

[Hidden]

Hi,

Liver enzymes can fluctuate by small amounts for many reasons. If you are concerned about your liver and risk of fibrosis, then the fibroscan is the best indicator.