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ALT (Alanine Aminotransferase) Test

Alt yazili porno depoda

An alanine aminotransferase (ALT) test measures the level of the enzyme ALT in your blood. This test can help doctors evaluate liver function or determine the underlying cause of a liver problem.

ALT is an enzyme that is found mostly in the liver. The liver is the body’s largest gland. It has several important functions, including:

  • making proteins
  • storing vitamins and iron
  • removing toxins from your blood
  • producing bile, which aids in digestion

Proteins called enzymes help the liver break down other proteins so your body can absorb them more easily. ALT is one of these enzymes. It plays a crucial role in metabolism, turning food into energy. The ALT test is often part of an initial screening for liver disease.

What is an ALT test?

ALT is normally found inside liver cells. However, when your liver is damaged or inflamed, ALT can be released into your bloodstream. This causes serum ALT levels to rise.

An increase in ALT is often the first sign of a liver problem, and ALT is often elevated before other symptoms appear.

An ALT test is also known as a serum glutamic-pyruvic transaminase (SGPT) test or an alanine transaminase test.

Why is an ALT test done?

The ALT test is usually used to determine whether someone has liver injury or failure. Your doctor may order an ALT test if you’re having symptoms of liver disease, including:

  • jaundice , which is yellowing of your eyes or skin
  • pain in the right upper quadrant of your abdomen

Liver damage generally causes an increase in ALT levels. The ALT test can evaluate the levels of ALT in your bloodstream, but it can’t show how much liver damage there is or how much fibrosis, or scarring, is present.

The test also can’t predict how severe the liver damage will become.

An ALT test is often done with other liver enzyme tests. Checking ALT levels along with levels of other liver enzymes can provide your doctor with more specific information about a liver problem.

An ALT test may be part of a routine checkup or requested if someone has risk factors for liver disease, including:

  • family history
  • heavy alcohol use
  • exposure to hepatitis
  • taking certain medications

Other reasons to perform an ALT test include:

  • monitoring the progression of liver diseases, such as hepatitis or liver failure
  • assessing whether treatment for liver disease should be started
  • evaluating how well treatment is working

How do I prepare for an ALT test?

An ALT test doesn’t require any special preparation. However, you should tell your doctor about any prescription or over-the-counter medications you’re taking. Some medications may affect the levels of ALT in your blood.

Your doctor might tell you to avoid taking certain medications for a period of time before the test.

How is an ALT test performed?

An ALT test involves taking a small sample of blood, as outlined here:

  • A healthcare professional uses an antiseptic to clean your skin in the area where they will take the sample.
  • They will tie an elastic band around your upper arm, which stops the flow of blood and makes the veins in your arm more visible.
  • Once they find a vein, they will insert a needle. This may cause a brief pinching or stinging sensation. The blood is drawn into a tube attached to the end of the needle. In some cases, more than one tube may be required.
  • After enough blood has been collected, the healthcare professional removes the elastic band and the needle. They place a piece of cotton or gauze over the puncture site and cover that with a bandage or tape to keep it in place.
  • The blood sample is sent to a laboratory for analysis.
  • The laboratory sends the test results to your doctor. Your doctor may schedule an appointment with you to explain the results in more detail.

What are the risks associated with an ALT test?

An ALT is a simple blood test with few risks. Bruising can sometimes occur in the area where the needle was inserted. The risk of bruising can be minimized by applying pressure to the injection site for several minutes after the needle is removed.

In very rare cases, the following complications can occur during or after an ALT test:

  • excessive bleeding where the needle was inserted
  • an accumulation of blood beneath your skin, which is called a hematoma
  • lightheadedness or fainting at the sight of blood
  • an infection at the puncture site

What do my ALT test results mean?

Normal results.

According to the American College of Gastroenterology, the normal value for ALT in blood for people without risk factors for liver disease ranges from 29 to 33 international units per liter (IU/L) for males and 19 to 25 IU/L for females. This value can vary depending on the lab.

This range can be affected by certain factors, including sex and age. It’s important to discuss your specific results with your doctor.

Abnormal results

Higher-than-normal levels of ALT can indicate liver damage. Increased levels of ALT may be a result of:

  • hepatitis , which is an inflammatory condition of the liver
  • cirrhosis , which is severe scarring of the liver
  • death of liver tissue
  • a tumor or cancer in the liver
  • a lack of blood flow to the liver
  • hemochromatosis , which is a disorder that causes iron to build up in the body
  • mononucleosis , which is an infection usually caused by the Epstein-Barr virus

Most lower ALT results indicate a healthy liver. However, studies have shown that lower-than-normal results have been related to increased long-term mortality. Discuss your numbers specifically with your doctor if you’re concerned about a low reading.

If your test results indicate liver damage or disease, you may need more testing to determine the underlying cause of the problem and the best way to treat it.

Last medically reviewed on June 7, 2021

How we reviewed this article:

  • Alanine aminotransferase (ALT). (2019). labtestsonline.org/tests/alanine-aminotransferase-alt
  • ALT Blood Test. (2020). medlineplus.gov/lab-tests/alt-blood-test/
  • Kwo P, et al. (2017). ACG clinical guideline: Evaluation of abnormal liver chemistries. journals.lww.com/ajg/fulltext/2017/01000/acg_clinical_guideline__evaluation_of_abnormal.13.aspx
  • Peltz-Sinvani N, et al. (2016). Low ALT levels independently associated with 22-year all-cause mortality among coronary heart disease patients. ncbi.nlm.nih.gov/pmc/articles/PMC4720656/

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

Current Version

Jun 7, 2021

Medically Reviewed By

Lauren Castiello, MS, AGNP-C

Sep 29, 2018

Karla Blocka

John Bassham

Copy Edited By

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ALT Blood Test

What is an alt blood test.

ALT stands for alanine transaminase. It is an enzyme found mostly in the liver. An ALT test measures the amount of ALT in the blood.

When liver cells are damaged, they release ALT into the bloodstream. High levels of ALT in your blood may be a sign of a liver injury or disease. Some types of liver disease cause high ALT levels before you have symptoms of the disease. So, an ALT blood test may help diagnose certain liver diseases early.

Other names: Alanine aminotransferase (ALT), Serum Glutamic-Pyruvic Transaminase (SGPT), GPT

What is it used for?

An ALT blood test is often part of a routine blood screening to check the health of your liver. The test may also help diagnose or monitor liver problems.

Why do I need an ALT blood test?

Your health care provider may order an ALT blood test, as part of a routine checkup. An ALT test is usually done with a group of other liver function tests that check how well your liver is working. These tests may also be ordered if you have symptoms of liver damage, such as:

  • Nausea and vomiting
  • Lack of appetite
  • Jaundice , a condition that causes your skin and eyes to turn yellow
  • Swelling and/or pain in your abdomen (belly)
  • Swelling in your ankles and legs
  • Dark-colored urine (pee) and/or light-colored stool (poop)
  • Frequent itching

Your provider may also order an ALT blood test if you have a high risk for liver damage because of:

  • A family history of liver disease
  • Alcohol abuse disorder (AUD)
  • Taking certain medicines that can cause liver damage
  • Hepatitis or exposure to hepatitis

What happens during an ALT blood test?

A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

Will I need to do anything to prepare for the test?

You don't need any special preparations for an ALT blood test. But an ALT test is usually ordered with other blood tests. You usually need to fast (not eat or drink) for several hours before these tests. Your provider will let you know if there are any special instructions to follow.

Are there any risks to the test?

There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

What do the results mean?

An ALT blood test is often done as part of a group of liver function tests. Liver function tests measure several different proteins, substances, and enzymes that show how well your liver is working. Your provider usually compares your ALT results with the results of the other liver tests to evaluate your liver health and to decide if you need other tests to make a diagnosis.

In general, high levels of ALT may be a sign of liver damage from hepatitis, infection, cirrhosis , liver cancer , or other liver diseases. The damage may also be from a lack of blood flow to the liver or certain medicines or poisons.

If your results show you have a high level of ALT, it doesn't always mean that you have a medical condition that needs treatment. Many things can affect your results, such as your age, sex, certain medicines and dietary supplements, intense exercise, how much you weigh, and having a menstrual period.

To learn what your results mean, talk with your provider. And be sure tell your provider about all the medicines and supplements you take.

Learn more about laboratory tests, reference ranges, and understanding results .

Is there anything else I need to know about an ALT blood test?

ALT test results may help tell the difference between damage from acute (sudden) liver problems and chronic (long-term) liver problems. But the amount of ALT in your blood isn't related to how much your liver may be damaged.

ALT used to be called SGPT, which stands for serum glutamic-pyruvic transaminase. The ALT blood test was formerly known as the SGPT test.

  • American Liver Foundation. [Internet]. New York: American Liver Foundation; c2022. . Diagnosing Liver Disease – Liver Biopsy and Liver Function Tests; [updated 2020 Feb 17; cited 2022 Feb 16]; [about 3 screens]. Available from: https://liverfoundation.org/for-patients/about-the-liver/diagnosing-liver-disease/
  • Hinkle J, Cheever K. Brunner & Suddarth's Handbook of Laboratory and Diagnostic Tests. 2nd Ed, Kindle. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. Alanine Aminotransferase (ALT); p. 31.
  • Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; 2022. Elevated liver enzymes; [cited 2022 Feb 24]; [about 3 screens]. Available from: https://www.mayoclinic.org/symptoms/elevated-liver-enzymes/basics/definition/sym-20050830
  • Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c2022. Liver disease; [cited 2022 Feb 24]; [about 8 screens]. Available from: https://www.mayoclinic.org/diseases-conditions/liver-problems/symptoms-causes/syc-20374502
  • National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Blood Tests; [updated 2022 Mar 24; cited 2022 Feb 24]; [about 5 screens]. Available from: https://www.nhlbi.nih.gov/health/blood-tests
  • Testing.com [Internet]. Seattle (WA).: OneCare Media; c2022–. Alanine Aminotransferase (ALT); [modified 2021 Nov 9; cited 2022 Feb 24]; [about 14 screens]. Available from: https://www.testing.com/tests/alanine-aminotransferase-alt/
  • Testing.com [Internet]. Seattle (WA).: OneCare Media; c2022. Liver Panel; [modified 2021 Nov 9; cited 2022 Feb 24]; [about 13 screens]. Available from: https://www.testing.com/tests/liver-panel/
  • University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2022. Health Encyclopedia: ALT; [cited 2022 Feb 24]; [about 4 screens]. Available from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=alt_sgpt

The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

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Alanine Transaminase (ALT)

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What is alanine transaminase (ALT)?

Alanine transaminase (ALT), also known as alanine aminotransferase, is an enzyme that’s mainly found in your liver , though it exists in other parts of your body.

An enzyme is a type of protein in a cell that acts as a catalyst and allows certain bodily processes to happen. There are thousands of enzymes throughout your body that have important functions.

What is an ALT blood test?

An alanine transaminase (ALT) blood test measures the amount of ALT in your blood. ALT levels in your blood can increase when your liver is damaged, so healthcare providers often use an ALT blood test to help assess the health of your liver.

Since many types of liver problems can cause ALT levels to increase, healthcare providers don't use the test alone to diagnose conditions. An ALT blood test is most often included in a blood test panel, such as a liver enzyme panel (HFP or LFT) or a comprehensive metabolic panel (CMP). A blood panel measures several aspects of your blood with one sample and can provide more detailed information about your overall health.

Common names for an ALT blood test include:

  • Alanine transaminase (ALT).
  • Alanine aminotransferase.
  • Serum glutamic-pyruvic transaminase.

How is alanine transferase (ALT) different from aspartate transferase (AST)?

Aspartate transferase (AST) is another enzyme that’s commonly measured along with AST in a liver function panel or comprehensive metabolic panel. Both of these enzymes can leak into your bloodstream when certain cells in your body are damaged.

AST and ALT are both commonly considered liver enzymes, but there are greater amounts of AST in other parts of your body, such as your heart, skeletal muscles and pancreas. Because of this, ALT is considered to be more directly tied to your liver health, but healthcare providers use both measurements to assess the health of your liver.

Why do I need an ALT blood test?

The purpose of an ALT blood test is to help evaluate the health of your liver. If cells in your liver are damaged, it can cause ALT to leak into your blood, so an ALT blood test can help find liver issues.

Your healthcare provider may order a blood panel test that includes an ALT test for you to help screen for, monitor or help diagnose liver conditions.

Screening means checking for potential health issues before you experience symptoms. Your healthcare provider will likely recommend screening with a liver panel blood test that includes an ALT test if you have risk factors for liver disease , which include:

  • Heavy alcohol use .
  • Family history of liver disease.
  • Injecting drugs using shared needles.

Since ALT tests are often included in routine blood panel tests that assess your general overall health, such as a comprehensive metabolic panel (CMP), you may have an ALT test even if you don’t have risk factors for liver disease.

If you have a liver condition, your provider may order an ALT test, often as part of a panel, to monitor your condition to see if it’s improving, worsening or staying the same with or without treatment. Your provider may also have you undergo an ALT test and liver enzyme panel test if you’re taking a medication that can affect your liver health.

Your provider may use an ALT test for diagnostic purposes when you’re experiencing signs and symptoms of possible liver problems. While providers can’t diagnose a condition based solely on ALT levels, it can be an important part of the diagnostic process.

Signs and symptoms of liver conditions include:

  • Nausea and/or vomiting .
  • Belly (abdominal) pain .
  • Itchy skin.
  • Jaundice (a yellowing of your skin and the whites of your eyes).
  • Tiredness (fatigue) .
  • Appetite loss.

Test Details

Who performs an alt blood test.

A healthcare provider called a phlebotomist usually performs blood draws, including those for an ALT blood test, but any healthcare provider trained in drawing blood can perform this task. The samples are sent to a lab where a medical laboratory scientist prepares the samples and performs the test on machines known as analyzers.

Do I need to fast for an ALT blood test?

If your ALT test is part of a comprehensive metabolic panel (CMP) , you’ll likely need to fast for 10 to 12 hours before your CMP blood test. Fasting means not eating or drinking anything other than water.

It’s not as common, but if you’re only getting an ALT blood test, you don’t need to fast.

In any case, your healthcare provider will give you instructions when they order the bloodwork. Be sure to follow their directions.

Do I need to do anything to prepare for an ALT blood test?

Many different types of medications and supplements can affect your ALT levels, so it’s important to tell your healthcare provider about any drugs or dietary supplements you’re taking before you get the test. In some cases, your provider may have you stop taking a medication before the test. Only stop taking medication if your provider tells you to do so.

Intense exercise can also affect your ALT levels, so tell your provider if you frequently do demanding physical workouts before you get the ALT test.

What should I expect during my ALT blood test?

You can expect to experience the following during a blood test, or blood draw:

  • You’ll sit in a chair, and a healthcare provider will check your arms for an easily accessible vein. This is usually in the inner part of your arm on the other side of your elbow.
  • Once they’ve located a vein, they’ll clean and disinfect the area.
  • They’ll then insert a small needle into your vein to take a blood sample. This may feel like a small pinch.
  • After they insert the needle, a small amount of blood will collect in a test tube.
  • Once they have enough blood to test, they’ll remove the needle and hold a cotton ball or gauze on the site to stop any bleeding.
  • They’ll place a bandage over the site, and you’ll be finished.

The entire procedure usually takes less than five minutes.

What should I expect after my ALT blood test?

After a healthcare provider has collected your blood sample, they’ll send it to a laboratory for testing. Once the test results are back, your healthcare provider will share the results with you.

What are the risks of an ALT blood test?

Blood tests are a very common and essential part of medical testing and screening. There’s very little risk to having blood tests. You may have slight tenderness or a bruise at the site of the blood draw, but this usually resolves quickly.

When can I expect the results of my ALT blood test?

In most cases, you should have your test results within one to two business days, though it could take longer.

Results and Follow-Up

What do the results of an alt blood test mean.

Blood test reports, including alanine transaminase (ALT) test reports, usually provide the following information:

  • The name of the blood test or what was measured in your blood.
  • The number or measurement of your blood test result.
  • The normal measurement range for that test.
  • Information that indicates if your result is normal or abnormal or high or low.

What is the normal range for an ALT blood test?

The normal range for alanine transaminase (ALT) varies from laboratory to laboratory. One common reference range for an ALT blood test is 7 to 56 U/L (units per liter). ALT levels are typically higher in people assigned male at birth than in people assigned female at birth.

Since ranges can vary depending on the laboratory, it’s important to check your test result report to see what your specific lab’s reference range is.

What does it mean if my alanine transaminase (ALT) is high?

High levels of ALT in your blood can be due to damage or injury to the cells in your liver. An increased ALT level may indicate the following conditions:

  • Alcohol-induced liver injury.
  • Fatty liver disease (too much fat in your liver).
  • Hepatitis (liver inflammation).
  • Cirrhosis (scarring of the liver).
  • Taking medications that are toxic to your liver.
  • Liver tumor or liver cancer .
  • Liver ischemia (not enough blood flow to your liver, which leads to death of liver tissue).
  • Hemochromatosis (having too much iron in your body).
  • Mononucleosis ("mono").
  • Certain genetic conditions can affect your liver.

Although it’s less common, elevated ALT levels can also indicate injury to cells in other parts of your body, since ALT isn’t solely found in your liver.

It’s important to know that having a high ALT test result doesn't necessarily mean you have a medical condition. Less than 5% of people with elevated ALT levels have severe liver conditions. Other factors can affect your ALT levels. Your provider will take into consideration several factors, including other blood test results and your medical history, when analyzing your results.

What does it mean if my alanine transaminase (ALT) is low?

Having a lower than normal ALT result is uncommon and usually isn’t a cause for concern. However, a lower than normal ALT level could indicate a vitamin B6 deficiency or chronic kidney disease .

If your ALT result is lower than what's considered normal, your healthcare provider will likely have you retake the test or undergo further testing to make sure nothing is causing your low level.

Should I be worried if I have high or low alanine transaminase (ALT) test results?

If your ALT test result is high or low, it doesn't necessarily mean that you have a medical condition that needs treatment. Other factors can affect your levels, including:

  • Exercise : Intense or extreme exercise can cause a temporary increase in ALT levels.
  • Medications : Several medications and supplements can affect ALT levels, including over-the-counter pain medications such as acetaminophen.
  • Sex : Scientists believe hormonal differences contribute to sex differences in ALT levels.
  • Menstruation : ALT levels can increase or decrease during your menstrual cycle.
  • Age : ALT levels tend to decrease with older age.
  • Heritage : Research shows that people who have Mexican-American heritage are more likely to have elevated levels of ALT.
  • Body mass index : Several studies have revealed an association between ALT levels and body mass index (BMI), which may change the interpretation of test results in people who have obesity.

In addition to the above factors, when analyzing your ALT results, your healthcare provider will take into consideration many aspects of your health and situation, including:

  • Your medical history.
  • How high or low your ALT results are.
  • Previous ALT results.
  • The results of other tests usually taken alongside ALT.
  • If you’re experiencing symptoms.

Do I need follow-up tests if my ALT results are abnormal?

It’s common for healthcare providers to recommend follow-up tests if you have an abnormal ALT level.

Follow-up testing may include:

  • Repeat ALT blood tests.
  • Other blood tests.
  • Imaging tests.

Additional testing may be immediate if you have significantly elevated ALT levels and/or are experiencing symptoms of a liver condition.

Every person and situation is unique, so there’s no single follow-up testing plan that works for everyone. Together, you and your provider will determine the best plan.

When should I call my doctor?

If you’re experiencing symptoms of liver damage, such as jaundice or belly pain, call your healthcare provider.

If you’ve been diagnosed with a liver condition and are experiencing new or concerning symptoms, contact your provider.

If you have any questions about your alanine transaminase (ALT) results, don’t be afraid to ask your provider questions.

A note from Cleveland Clinic

Seeing an abnormal test result can be stressful. Know that having a high level of alanine transaminase (ALT) doesn’t necessarily mean you have a medical condition and need treatment. Many factors can affect your ALT levels, and 1 in 20 healthy people will have results outside of the normal range. Your healthcare provider will let you know if you need to undergo further tests to determine the cause of the abnormal level. Don’t be afraid to ask your provider questions. They’re there to help you.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

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Regulation of Bile Release

Functions of bile salts, what does alt mean in a blood test, when is alt test ordered, what conditions other than liver problems can cause increased alt, viral hepatitis (mainly hepatitis b virus [hbv] and hepatitis c virus [hcv] infections), alcohol intake, some medications, coffee consumption, non-alcoholic fatty liver disease (nafld), autoimmune hepatitis, metabolic covariates, celiac disease and muscle injury, hemochromatosis, what is alt test.

ALT is short for alanine aminotransferase is also called SGPT (Serum Glutamic-Pyruvic Transaminase) or GPT (Glutamic-Pyruvic Transaminase) or alanine transaminase, which is an enzyme found mostly in the cells of the liver and kidney. Much smaller amounts of ALT are also found in the heart and muscles. ALT blood test measures the level of ALT (alanine aminotransferase) in the blood. Normal ALT are less than 36U/L [7 to 55 units per liter (U/L)]. This result is typical for adult men. Normal results vary from laboratory to laboratory and might be slightly different for women and children (neonate < 50 U/L).

The function of ALT (alanine aminotransferase) is to convert alanine, an amino acid found in proteins, into pyruvate, an important intermediate in cellular energy production. In healthy individuals, ALT levels in the blood are low. When the liver is damaged, ALT is released into the blood, usually before more obvious signs of liver damage occur, such as jaundice. This makes ALT (alanine aminotransferase) a useful test for early detection of liver damage.

A number of conditions can cause damage to liver cells, resulting in an increase in ALT. The ALT (alanine aminotransferase) test is most useful in detecting damage due to hepatitis or as a result of drugs or other substances that are toxic to the liver. ALT (alanine aminotransferase) is more specific for hepatocellular damage than is AST (aspartate aminotransferase) or LD (lactate dehydrogenase) and remains elevated for longer, due to its longer half-life.

ALT is commonly tested in conjunction with aspartate aminotransferase (AST), another liver enzyme, as part of a liver panel. Both ALT and AST levels usually rise whenever the liver is being damaged, although ALT is more specific for the liver and, in some cases, may be the only one of the two to be increased. An AST/ALT ratio may be calculated to aid in distinguishing between different causes and severity of liver injury and to help distinguish liver injury from damage to heart or muscles. The AST/ALT ratio is typically > 1 in alcoholic liver disease and AST/ALT < 1 in non-alcoholic liver disease.

ALT may be elevated in skeletal muscle disease but the degree of elevation is much less than for AST (aspartate aminotransferase) and CK (creatine kinase).

Your liver is the largest organ inside your body, weighing about 1.4 kg (3 pounds) in an average adult. Your liver is a vital organ located in the upper right-hand side of the abdominal cavity, just inferior to the diaphragm in the right superior part of the abdominal cavity and under your right ribs just beneath your right lung – filling much of the right hypochondriac and epigastric regions and extending into the left hypochondriac region.

Your liver is partially surrounded by the ribs, and extends from the level of the fifth intercostal space to the lower margin of the right rib cage, which protects this highly vascular organ from blows that could rupture it. Your liver is shaped like a wedge, the wide base of which faces right and the narrow apex of which lies just inferior to the level of the left nipple. The reddish-brown liver is well supplied with blood vessels.

Your liver is involved in many important functions in the body. Your liver helps to process your body’s nutrients, manufactures bile to help digest fats, produces many important proteins such as blood clotting factors, and breaks down potentially toxic substances into harmless ones that the body can use or excrete.

Figure 1. Location of the human liver

Alt yazili porno depoda

Figure 2. Liver lobule

Alt yazili porno depoda

Footnote: (a) Cross section of a hepatic lobule. (b) Enlarged longitudinal section of a hepatic lobule. (c) Light micrograph of hepatic lobules in cross section.

Liver functions

Amazingly versatile, your liver performs over 500 functions. Its digestive function is to produce bile, a green alkaline liquid that is stored in the gallbladder and secreted into the duodenum. Bile salts emulsify fats in the small intestine; that is, they break up fatty nutrients into tiny particles, just as dish detergent breaks up a pool of fat drippings in a roasting pan. These smaller particles are more accessible to digestive enzymes from the pancreas. The liver also performs many metabolic functions and you cannot live without your liver:

  • Picks up glucose from nutrient-rich blood returning from the alimentary canal and stores this carbohydrate as glycogen for subsequent use by the body.
  • Processes fats and amino acids and stores certain vitamins.
  • Detoxifies many poisons and drugs in the blood.
  • Makes the blood proteins.
  • It breaks down and stores many of the nutrients absorbed from the intestine that your body needs to function. Some nutrients must be changed (metabolized) in the liver before they can be used for energy or to build and repair body tissues.
  • It makes most of the clotting factors that keep you from bleeding too much when you are cut or injured.
  • It secretes bile into the intestines to help absorb nutrients (especially fats).
  • It breaks down alcohol, drugs, and toxic wastes in the blood, which then pass from the body through urine and stool.

Almost all of these functions are carried out by a type of cell called a hepatocyte or simply a liver cell.

The liver carries on many important metabolic activities. The liver plays a key role in carbohydrate metabolism by helping maintain concentration of blood glucose within the normal range. Liver cells responding to the hormone insulin lower the blood glucose level by polymerizing glucose to glycogen. Liver cells responding to the hormone glucagon raise the blood glucose level by breaking down glycogen to glucose or by converting noncarbohydrates into glucose.

The liver’s effects on lipid metabolism include oxidizing (breaking down) fatty acids at an especially high rate; synthesizing lipoproteins, phospholipids, and cholesterol; and converting excess portions of carbohydrate molecules into fat molecules. The blood transports fats synthesized in the liver to adipose tissue for storage.

Other liver functions concern protein metabolism . They include deaminating amino acids; forming urea; synthesizing plasma proteins such as clotting factors; and converting certain amino acids into other amino acids.

The liver also stores many substances, including glycogen, iron, and vitamins A, D, and B12. In addition, macrophages in the liver help destroy damaged red blood cells and phagocytize foreign antigens. The liver also removes toxic substances such as alcohol and certain drugs from blood (detoxification).

Table 1. Major Functions of the Liver

Polymerizes glucose to glycogen; breaks down glycogen to glucose; converts noncarbohydrates to glucose
Oxidizes fatty acids; synthesizes lipoproteins, phospholipids, and cholesterol; converts excess portions of carbohydrate molecules into fats
Deaminates amino acids; forms urea; synthesizes plasma proteins; converts certain amino acids into other amino acids
Stores glycogen, iron, and vitamin A, vitamin D and vitamin B12
Removes damaged red blood cells and foreign substances by phagocytosis
Removes toxins from blood
Produces and secretes bile

Bile is a yellowish-green liquid continuously secreted from hepatic cells. In addition to water, bile contains bile salts, bile pigments (bilirubin and biliverdin), cholesterol, and electrolytes. Of these, bile salts are the most abundant and are the only bile components that have a digestive function.

Bile pigments are breakdown products of hemoglobin from red blood cells and are normally secreted in the bile.

Jaundice, a yellowing of the skin and mucous membranes due to accumulation of bile pigment, has several causes. In obstructive jaundice bile ducts are blocked, perhaps by gallstones or tumors. In hepatocellular jaundice the liver is diseased, as in cirrhosis or hepatitis. In hemolytic jaundice red blood cells are destroyed too rapidly, as happens with an incompatible blood transfusion or a blood infection.

Normally bile does not enter the duodenum until cholecystokinin stimulates the gallbladder to contract. The intestinal mucosa releases this hormone in response to proteins and fats in the small intestine. The hepatopancreatic sphincter usually remains contracted until a peristaltic wave in the duodenal wall approaches it. Then the sphincter relaxes, and bile is squirted into the duodenum.

Bile salts aid digestive enzymes. Bile salts affect fat globules (clumped molecules of fats) much like a soap or detergent would affect them. That is, bile salts break fat globules into smaller droplets that are more soluble in water. This action, called emulsification, greatly increases the total surface area of the fatty substance. The resulting fat droplets disperse in water. Fat-splitting enzymes (lipases) can then digest the fat molecules more effectively. Bile salts also enhance absorption of fatty acids, cholesterol, and the fat-soluble vitamins A, D, E, and K.

Low levels of bile salts result in poor lipid absorption and vitamin deficiencies.

The alanine aminotransferase (ALT) test is typically used to detect liver injury. It is often ordered in conjunction with aspartate aminotransferase (AST) as part of a liver panel or comprehensive metabolic panel (CMP) to screen for and/or help diagnose liver disease.

ALT is an enzyme found mostly in the cells of the liver and kidney. When the liver is damaged, ALT is released into the blood. This makes ALT a useful test for early detection of liver damage.

AST and ALT are considered to be two of the most important tests to detect liver injury, although ALT is more specific to the liver than is AST. Sometimes AST is compared directly to ALT and an AST/ALT ratio is calculated. This ratio may be used to distinguish between different causes of liver damage and to help recognize heart or muscle injury.

ALT values are often compared to the results of other tests such as alkaline phosphatase (ALP), total protein, and bilirubin to help determine which form of liver disease is present.

ALT is often used to monitor the treatment of persons who have liver disease, to see if the treatment is working, and may be ordered either by itself or along with other tests for this purpose.

ALT may be ordered as part of a comprehensive metabolic panel when a person has a routine health examination.

A healthcare practitioner usually orders an ALT test (and several others) to evaluate a person who has signs and symptoms of a liver disorder. Some of these signs and symptoms may include:

  • Weakness, fatigue
  • Loss of appetite
  • Nausea, vomiting
  • Abdominal swelling and/or pain
  • Dark urine, light-colored stool
  • Itching (pruritus)

ALT may also be ordered, either by itself or with other tests, for people who are at an increased risk for liver disease since many people with mild liver damage will have no signs or symptoms. Even without other symptoms, ALT will be increased with mild liver damage. Some examples include:

  • Persons who have a history of known or possible exposure to hepatitis viruses
  • Those who are heavy drinkers
  • Individuals whose families have a history of liver disease
  • Persons who take drugs that might damage the liver
  • Persons who are overweight and/or have diabetes

When ALT is used to monitor the treatment of people who have liver disease, it may be ordered on a regular basis during the course of treatment to determine whether the therapy is effective.

Alt test range

ALT blood test normal range: Normal ALT are less than 36U/L [7 to 55 units per liter (U/L)]. This result is typical for adult men. Normal results vary from laboratory to laboratory and might be slightly different for women and children (neonate < 50 U/L).

A low level of ALT in the blood is expected and is normal.

ALT blood test high

Liver disease is the most common reason for higher than normal levels of ALT.

A shot or injection of medicine into the muscle tissue, or strenuous exercise, may increase ALT levels. And many drugs may raise ALT levels by causing liver damage in a very small percentage of patients taking the drug. This is true of both prescription drugs and some “natural” health products. Be sure to tell your healthcare provider about all of the drugs and/or health supplements you are taking.

Very high levels of ALT (more than 10 times normal) are usually due to acute hepatitis, sometimes due to a viral infection. In acute hepatitis, ALT levels usually stay high for about 1-2 months but can take as long as 3-6 months to return to normal. Levels of ALT may also be markedly elevated (sometimes over 100 times normal) as a result of exposure to drugs or other substances that are toxic to the liver or in conditions that cause decreased blood flow (ischemia) to the liver.

ALT levels are usually not as high in chronic hepatitis, often less than 4 times normal. In this case, ALT levels often vary between normal and slightly increased, so the test may be ordered frequently to see if there is a pattern. Other causes of moderate increases in ALT include obstruction of bile ducts, cirrhosis (usually the result of chronic hepatitis or bile duct obstruction), heart damage, alcohol abuse, and with tumors in the liver.

ALT is often performed together with a test for AST or as part of a liver panel. For more about ALT results in relation to other liver tests, see the Liver Panel article.

In most types of liver diseases, the ALT level is higher than AST and the AST/ALT ratio will be low (less than 1). There are a few exceptions; the AST/ALT ratio is usually greater than 1 in alcoholic hepatitis, cirrhosis, and with heart or muscle injury and may be greater than 1 for a day or two after onset of acute hepatitis.

ALT is more specific for the liver than AST and so is much less affected by conditions affecting other parts of the body. Nevertheless, injury to organs other than the liver, such as the heart and skeletal muscle, can cause elevations of ALT. For example, small increases may be seen with skeletal muscle damage or heart attacks.

What other tests may be performed to help determine the cause of liver damage?

After a thorough physical exam and evaluation of a person’s medical history, there are several other tests that may be performed as follow up depending on what is suspected to be the cause of liver damage. Some of these include:

  • Tests for hepatitis A, hepatitis B, and hepatitis C
  • Testing for exposure to drugs and other substances toxic to the liver (see Drug Abuse Testing and Emergency and Overdose Drug Testing)
  • Ethanol level
  • Copper and ceruloplasmin for Wilson disease
  • Iron tests and genetic tests for hereditary hemochromatosis

A liver biopsy may be performed to help determine the cause of liver injury and to evaluate the extent of liver damage.

How is the sample collected for testing?

A blood sample is drawn from a vein in the arm.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

Hepatic-related causes of high ALT

Viral hepatitis infection is the leading or secondary cause of ALT elevation in populations worldwide 1) . ALT activity is an indicator of liver injury in patients with acute and chronic viral hepatitis 2) .

With respect to hepatitis B virus (HBV) infection, ALT elevation is often observed in the process of the cytolytic immune response (acute phase) and the following ineffective HBV clearance (chronic phase) 3) . Liaw et al 4) have described a fluctuation in ALT activity during the process of HBV infection. ALT activity is a crucial reference indicator in treatment selection and the evaluation of prognosis in patients infected with HBV 5) . Nevertheless, controversy exists and Lai et al 45 reported significant fibrosis and inflammation in 37% of patients infected with HBV and persistently normal ALT levels 6) . Unlike hepatitis B virus (HBV) infections, the ALT level is less meaningful for diagnosis and prognosis of hepatitis C virus (HCV) treatment. More patients infected with hepatitis C virus (HCV) progress to chronic hepatitis with persistent hepatocyte injury 7) . Greater than 6 in 10 of common hepatitis C virus (HCV) carriers have normal ALT levels or mildly elevated ALT levels (< 2 times the upper limit of normal) with rare hepatic histologic lesions confirmed by liver biopsy 8) . Recently, Ruhl et al 9) suggested that lowering the upper limit of normal of the ALT level (29 IU/L for men and 22 IU/L for women) was the best cut-off value to identify hepatitis C virus (HCV) infectors in the US population with a high prevalence of hepatitis C virus (HCV) infection. Otherwise, the HCV RNA titer is closely linked to the ALT elevation. Cathy et al 10) reported that approximately 68% of patients with positive HCV-RNA levels have ALT elevations in asymptomatic blood donors who tested positive for antibodies to the HCV (anti-HCV).

Excessive alcohol intake is another cause of ALT elevation in the general population. In an Italian population, 45.6% of altered liver tests have been attributed to excessive alcohol intake (≥28 g/day) 35, while in a US national population survey, excessive alcohol (>1 time/day) is a crucial cause of ALT elevation, second only to hepatitis C virus (HCV) infection 11) , however, alcohol intake might be a time-and dose-dependent covariate that influences ALT activity. Short-term and light alcohol consumption was not shown to induce significant ALT elevation in adults 12) , however, ethnicity differences exist regarding the biological consequences of alcohol abuse 13) . In a UK study based on alcohol abusers from different areas worldwide, adults from South Asia were shown to be more susceptible to alcohol-related liver damage and the ALT levels were higher than in European alcohol abusers 14) . Indeed, the effect of mild alcohol intake on ALT activity can be distinguished from binge drinking. Moderate alcohol intake does not contribute to significant ALT elevation, especially in a normal weight population, due to its potential effect on improvement of insulin sensitivity 15) .

Pratt et al 16) listed the medications that might cause ALT elevations. A randomized controlled trial indicated that the estimated odds ratios of ALT elevation in active treatment groups (including acetaminophen, paracetamol, hydromorphone+acetaminophen, morphine+acetaminophen, and oxycodone+acetaminophen) were 2.57-3.08 compared to the placebo group involving 343 healthy participants, even at the recommended dose 17) . Another commonly used medication, statins, also causes mild ALT elevation 18) . The mechanism underlying statin-associated ALT elevation is still unclear. Some scholars have suggested that the ALT elevation in statin users is attributed to cholesterol reduction in hepatocytes and co-morbid conditions, rather than liver damage or dysfunction 19) . Therefore, the long-term medications should be carefully considered when faced with an unexplained ALT elevation. Pratt et al 20) also indicated that cessation of drug treatment is the best way to confirm the relationship between a drug and ALT elevation.

Of note, coffee intake might be a protective factor against ALT elevation. In NHANES III, there was a 50% and 70% decrease in ALT elevation amongst participants who consumed >2 cups of coffee/day or ≥373 mg of caffeine, respectively, compared to participants who did not consume coffee 21) . Lee et al 22) attributed the protective effects of caffeine to antioxidant activity.

NAFLD is a spectrum of clinical and pathologic changes, from fatty liver alone to steatohepatitis 23) . Non-alcoholic fatty liver disease (NAFLD) is common in asymptomatic patients, and the prevalence ranges from 10 to 24% worldwide 24) . Considered as a manifestation of the metabolic syndrome in liver 25) , NAFLD has been strongly associated with ALT activity in previous studies 26) . Non-alcoholic fatty liver disease (NAFLD) is the common cause of unexplained mild ALT elevation 27) . NAFLD in asymptomatic patients is often serendipitously detected by liver biochemistry testing during routine health check-ups 28) . Similar to the increasing prevalence of obesity 29) , NAFLD is increasing and becoming a major health burden 30) . In spite of the non-linear correlation between the degree of ALT elevation and the histologic severity of NAFLD 31) , a mild ALT elevation is largely attributed to NAFLD. When faced with an unexplained ALT elevation (without viral hepatitis or a history of excessive alcohol intake), NAFLD should be considered in the differential diagnosis.

Autoimmune hepatitis is a less common liver disease than NAFLD 32) , and the mechanism underlying autoimmune hepatitis is still unknown 33) . ALT elevation is an available auxiliary measurement in the diagnosis of autoimmune hepatitis 34) .

Moreover, ALT activity is a crucial indicator in detecting the effect of immunosuppressive treatment, prognosis, and long-term survival in patients with autoimmune hepatitis. In a study based on 84 Japanese autoimmune hepatitis patients, a persistently low ALT level (≤40 U/l) was the threshold value that was associated with improved prognosis 35) . Another study also showed an association between persistent ALT elevation and poor survival in 69 autoimmune hepatitis patients 36) . ALT is considered to be a crucial non-invasive marker of inflammation in patients with autoimmune hepatitis 37) .

Non-hepatic cause of high ALT

Except for apparent causes, such as viral hepatitis, alcohol intake, and some medications, the so-called unexplained causes of ALT elevation in some previous studies have mainly been attributed to metabolic syndrome 38) . Similar to the pandemic of obesity 39) , metabolic syndrome presents as a series of metabolic disorders, including glucose intolerance, central obesity, dyslipidaemia, and hypertension, has caused worldwide concern in the most recent decades.

Compared to the obvious cause of ALT elevation referred above, ALT elevation caused by metabolic syndrome is mild and neglected. In a cross-sectional study, the ALT level in metabolic syndrome patients, as defined by the National Cholesterol Education Programme Adult Treatment Panel III (NCEP-ATP-III) criteria, was approximately 30% higher than participants without metabolic syndrome in a male population from south China 40) . This impact of metabolic syndrome on ALT elevation, however, is progressive and cumulative with a linear trend 41) . Even within upper limit of normal values, which did not consider the impact of metabolic syndrome and are higher than the updated values, the increasing prevalence of metabolic syndrome is still correlated with the increasing ALT level in the general population. In a community-based Korean population, the odds ratios for metabolic syndrome in the highest quintiles of ALT were 7.1-fold higher than the reference quintile in men and 2.1-fold higher in women 42) . All of the enrolled participants were selected within the upper limit of normal values (the upper limit of normal value is 30 U/l for males and 19 U/l for females) 43) . Another Korean national health survey also showed a significantly increased prevalence of metabolic syndrome components, as defined by NCEP-ATP-III criteria, in the subgroup with high-normal ALT levels 44) . With respect to the lipoproteins, ALT was shown to be stably and significantly associated with intermediate-density lipoprotein (IDL) and apolipoprotein B (ApoB) after adjusting various covariates in different models 45) . These associations were commonly attributed to the stable and independent effects of insulin resistance and fatty liver disease in subjects with ALT elevations 46) .

In addition, the impact of metabolic syndrome components on ALT activities varies to some extent. These distinguishing effects emerged after logistic regression using all of the metabolic syndrome components as covariates. The impact of the individual metabolic syndrome components on ALT elevation was disproportionate 47) . The body mass index (BMI) and waist circumstance, representing the central obesity component of metabolic syndrome, were more closely linked to the ALT elevation 48) , although, the underlying mechanism has not been elucidated. The possible explanation is that obesity, especially abdominal fat, is potentially involved in the visceral adipose deposition that causes hepatotoxic fatty acids 49) . In a US national population-based study 50) , BMI lost significance when evaluating the association between obesity and ALT abnormities after adjusting for leptin, insulin, and triglyceride concentrations, rather than the waist circumstance, which was representative of the visceral adipose deposition, indicating that BMI might be an intrinsic association between obesity and ALT abnormalities. Another viewpoint was that the obesity-ALT elevation association was modulated by insulin resistance. In a national health survey from a Korean adolescent population, the prevalence of insulin resistance status was positively correlated with the degree of obesity 51) . The odds ratio of obesity-induced ALT elevation was significantly decreased after adjusting the homeostasis model as an index of insulin resistance status 52) . Despite the ill-defined intrinsic mechanism, central obesity is the crucial metabolic syndrome component that most influences the ALT level in general population.

Chronic ALT elevation is also found in several non-hepatic disorders, such as celiac disease and muscle injury 53) . The intrinsic mechanism between celiac disease is not known. Approximately 40-57% of patients with celiac disease have abnormal liver tests 54) . Celiac disease patients with elevated ALT levels should be treated with gluten-free diet; doing so will restore ALT levels to normal in 75-95% of patients within 6 months 55) . It is well known that ALT elevation is often observed in patients with muscle necrosis 56) and the ALT elevation without evidence of liver disease should be considered due to muscle injury 57) . Otherwise, the increased creatine kinaseand lactate dehydrogenase activities that occurred following muscle injury should be assayed to identify the cause of ALT elevation 58) .

As an ethnic specific disease mainly occurring in individuals of Nordic descent, hemochromatosis is a less common cause of ALT elevation. HFE gene mutations are the major cause of hereditary hemochromatosis, and iron overload is the main cause of hepatic injury. Measurements of serum ferritin, total iron-binding capacity, and the HEF mutation test can help diagnose hemochromatosis 59) . Liver biopsy might be necessary if the aforementioned tests are negative in patients highly suspected to have hemochromatosis to evaluate the status of liver injury from iron overload.

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ALT and AST Enzymes: Meaning of Low, Normal, High Levels

These blood tests check for possible liver injury

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Jay Yepuri, MD, MS, is board-certified in gastroenterology. He is a partner with Digestive Health Associates of Texas and a medical director at Texas Health Harris Methodist HEB Hospital .

  • When to Test

Roles of AST and ALT

During the test, normal lab values, ast/alt ratio, frequently asked questions.

Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are two of the liver enzymes healthcare providers look at when trying to figure out if you have a problem with your liver. Liver enzymes are substances produced by the liver that can be measured with a blood test. High ALT levels or high AST levels may be a sign of a liver problem.

When compared to each other, ALT and AST levels can help identify toxins in the liver, liver disease, or liver damage.

This article will discuss ALT and AST liver enzymes and what they do inside your body. It will also cover what happens during testing and what test results can reveal.

Verywell / Elise Degarmo

When Testing Is Recommended

ALT and AST levels are measured as part of a comprehensive testing panel known as the liver function test (LFT). An LFT may be ordered:

  • If you have symptoms of liver disease, including jaundice , dark urine, nausea , vomiting, and fatigue
  • To monitor the progression of a liver disease
  • To determine when certain drug treatments should be started
  • To check your response to a liver treatment

An LFT can also determine whether a drug (prescription or over-the-counter) or an herbal remedy is causing liver injury.

If the lab test is processed on-site, the results can be returned within hours. Otherwise, your doctor will usually receive the results in anywhere from one to three days.

Aminotransferases are chemicals the liver uses to make glycogen. Glycogen is the stored form of glucose , the sugar that the body uses for energy.

Any glucose not immediately used will be changed into glycogen. It is then stored in cells for future use. Most will be stored in the liver. The leftover amount will be warehoused in the:

  • Skeletal muscles
  • Glial cells of the brain
  • Other organs

Aspartate aminotransferase (AST) is found in a variety of tissues, including the liver, brain, pancreas , heart, kidneys , lungs, and skeletal muscles. If any of these tissues are damaged, AST will be released into the bloodstream. While high AST levels mean there may be tissue injury, it doesn't always relate to the liver.

By contrast, alanine aminotransferase (ALT) is found mainly in the liver. High ALT levels are always worrying, but they don't necessarily point to something serious. If your ALT level is high, it may indicate minor or severe liver injury.

Occasional increases in ALT may occur when you have a short-term infection or illness. Sustained increases are more serious. That's because this may mean there's an underlying disease and a greater chance of liver damage .

What Happens During Testing

ALT/AST levels are usually measured as part of a liver function test. This is a simple blood test, which may be done at a lab or hospital or in your healthcare provider's office.

Preparing for the Test

This test usually requires a period of fasting prior to the blood draw. This means you will be asked not to eat anything up to 12 hours before you arrive. Ask your healthcare provider if you need to stop taking any of your medications prior to the test. 

You will be asked to roll up your sleeve and expose the bend in your elbow. Your healthcare provider will clean the area and place a tight band around your arm above your elbow. You will be asked to make a fist to help make the vein easier to find.

You may feel a pinch when the needle is inserted. Your healthcare provider will place gauze over the site after the sample has been taken. 

After the Test

It's possible you may feel lightheaded immediately after the test. If so, wait until you feel better before attempting to drive home. 

You may have slight bruising where your blood was drawn. The area may feel sore for a day or two.

AST and ALT are measured in international units per liter (IU/L). The normal levels vary based on a person's body mass index (BMI) It also depends on the lab's reference value, or typical results. 

Generally speaking, a normal AST level for adults is: 8 to 48 IU/L. A normal ALT level for adults is 7 to 55 IU/L.

The high end of the reference range is referred to as the upper limit of normal (ULN). This number is used to establish how elevated your liver enzymes are.

Mild elevations are generally considered to be two to three times the ULN. With some liver diseases, the level can be more than 50 times the ULN. Levels this high are described as deranged.

While it may seem that a high ALT is all that is needed to diagnose liver disease, its relationship to AST can provide valuable clues as to what exactly is going on. It will also tell you whether the issue is acute (occurring suddenly and progressing rapidly) or chronic (long-standing or persistent).

If the liver experiences an acute injury, you can expect to see a sudden spike in the ALT. On the other hand, if liver disease is slowly progressing, the damage in the liver will gradually affect other organs too. As these organs are damaged, the AST will begin to rise.

This occurs with diseases like hepatitis C . It causes long-term liver damage that triggers symptoms involving:

These are referred to as extra-hepatic symptoms.

The relationship between these enzymes is described using the AST/ALT ratio. This is a calculation that compares the levels of AST and ALT in your blood. Depending on which value is elevated and the amount of elevation, doctors can often get a pretty strong indication as to what disease is involved.

What the AST/ALT Ratio Reveals

The AST/ALT ratio is important because its pattern can tell a lot about the condition involved. Here are the general guidelines used to diagnose liver disease:

  • An AST/ALT ratio of less than one (where the ALT is significantly higher than the AST) means you may have non-alcoholic fatty liver disease .
  • An AST/ALT ratio equal to one (where the ALT is equal to the AST) may be a sign of acute viral hepatitis or drug-related liver toxicity .
  • An AST/ALT ratio higher than one (where the AST is higher than ALT) means you may have cirrhosis .
  • An AST/ALT ratio higher than 2:1 (where the AST is more than twice as high as the ALT) is a sign of alcoholic liver disease.

However, a disease cannot be diagnosed by the pattern of elevation alone. How elevated the levels are also needs to be measured. This is described in multiples of the ULN. It is only when the levels are above a certain threshold that the ratio can be considered diagnostic.

The AST/ALT ratio is a comparison of the levels of the two enzymes. This measurement can point to liver diseases, but only if the enzyme levels are elevated several times above normal.

ALT and AST liver enzymes are produced by the liver. Doctors can test these levels with a blood test. If you have elevated liver enzymes, it could be a sign that you have liver disease.

AST is found in the liver, brain, pancreas, heart, kidneys, lungs, and skeletal muscles. ALT is found mainly in the liver.

If your AST levels are too high, it might be a sign of an injury affecting tissues other than the liver. High ALT levels may mean you have a liver injury. It could also be a sign that you have an infection or short-term illness.

The ratio of the two enzymes can help diagnose specific liver diseases.

A high AST (aspartate aminotransferase) level can indicate a problem with your liver. However, it does not usually mean you have a medical condition that needs treatment. It could be a side effect of medication. Very elevated AST levels can indicate hepatitis, cirrhosis, mononucleosis, heart problems, or pancreatitis.  

The upper limit of normal for AST is 48 IU/L. Levels that are double to triple the upper limit of normal are considered mildly elevated. In liver disease, AST levels can be 50 times the upper limit of normal. The medical term for this is deranged levels.

High levels of alanine transaminase (ALT) can indicate a liver problem but do not necessarily mean you have a health condition. Very elevated levels of ALT may be suggestive of liver damage from hepatitis, infection, liver cancer, or liver disease. High ALT levels may also be a side effect of certain medications.

The upper limit of normal for ALT is 55 IU/L. When an ALT level is double to triple the upper limit of normal, it is considered mildly elevated. Severely elevated ALT levels found in liver disease are often 50 times the upper limit of normal.

Johns Hopkins Medicine. Common liver tests .

National Library of Medicine. MedlinePlus. Liver Function Tests .

Stanford Health Care. Liver function tests .

U.S. National Library of Medicine: MedlinePlus. AST test .

Malakouti M, Kataria A, Ali SK, Schenker S. Elevated liver enzymes in asymptomatic patients - What should I do? J Clin Transl Hepatol . 2017;5(4):394-403. doi:10.14218/JCTH.2017.00027

U.S. National Library of Medicine: MedlinePlus. ALT blood test .

Newsome P, Cramb R, Davison S, et al. Guidelines on the management of abnormal liver blood tests . Gut.  2018;67:6-19. doi:10.1136/gutjnl-2017-314924.

By Charles Daniel  Charles Daniel, MPH, CHES is an infectious disease epidemiologist, specializing in hepatitis.

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  1. What High ALT Levels Mean and How to Lower Them

    Alanine aminotransferase (ALT) is an enzyme found inside liver cells. Liver enzymes, including ALT, help your liver break down proteins to make them easier for your body to absorb.

  2. ALT (Alanine Aminotransferase) Test

    An alanine aminotransferase (ALT) test measures the level of the enzyme ALT in your blood. This test can help doctors evaluate liver function or determine the underlying cause of a liver problem.

  3. ALT Blood Test: MedlinePlus Medical Test

    An ALT blood test is often done as part of a group of liver function tests. Liver function tests measure several different proteins, substances, and enzymes that show how well your liver is working. Your provider usually compares your ALT results with the results of the other liver tests to evaluate your liver health and to decide if you need other tests to make a …

  4. Alanine Transaminase (ALT)

    Alanine transaminase (ALT) is an enzyme that mainly exists in your liver. An ALT blood test is often included in a liver panel and comprehensive metabolic panel, and healthcare providers use it to help assess your liver health. High levels of ALT in your blood may indicate that you have damage to your liver and/or a liver condition.

  5. Alanine Aminotransferase (ALT) Test and Results (aka SGPT Test)

    ALT usually is done as part of a group of liver function tests called a liver panel. This panel also includes an aspartate aminotransferase (AST) test. AST is another liver enzyme.

  6. ALT Blood Test

    ALT is short for alanine aminotransferase is also called SGPT (Serum Glutamic-Pyruvic Transaminase) or GPT (Glutamic-Pyruvic Transaminase) or alanine transaminase, which is an enzyme found mostly in the cells of the liver and kidney. Much smaller amounts of ALT are also found in the heart and muscles.

  7. ALT and AST Liver Enzymes: Role, Testing, Normal Lab Values

    Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are two of the liver enzymes healthcare providers look at when trying to figure out if you have a problem with your liver. Liver enzymes are substances produced by the liver that can be measured with a blood test. High ALT levels or high AST levels may be a …

  8. What is ALT (SGPT), and how to lower it?

    ALT (Alanine Aminotransferase / SGPT) is a type of enzyme found in liver cells. When the liver cells are functioning normally, the ALT enzymes should be contained within the liver cells. You can imagine each liver cells as a balloon, and the ALT enzymes are the air inside the balloon. When the balloon is damaged, the air will be released.

  9. Altimmune, Inc. (ALT) Stock Price, News, Quote & History

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  10. Alt Codes List of Alt Key Codes Symbols

    Alt-Codes can be typed on Microsoft Operating Systems: First make sure that numlock is on, Then press and hold the ALT key, While keeping ALT key pressed type the code for the symbol that you want and release the ALT key. Unicode codes can not be typed. Codes can be used within HTML, Java..etc programming languages.