Review Note

MAGNITUDE OF AST AND ALT ELEVATIONS
• The magnitude of AST and ALT elevations varies depending on the cause of the hepatocellular injury.
• {{c1::Alcoholic fatty liver disease}}: AST {{c2::<8 times}} the upper limit of normal; ALT {{c2::<5}}
times the upper limit of normal.
• {{c1::Nonalcoholic fatty liver disease:}} AST and ALT {{c2::<4 times}} the upper limit of normal.
• {{c1::Acute viral hepatitis or toxin-related hepatitis with jaundice:}} AST and ALT {{c3::>25}}
times the upper limit of normal.
• {{c1::Ischemic hepatitis}} (ischemic hepatopathy, shock liver, hypoxic hepatitis): AST and
ALT {{c3::>50 times}} the upper limit of normal (in addition the lactate dehydrogenase is
often markedly elevated).
• {{c1::Chronic hepatitis C virus infection}}: Wide variability, typically normal to less than
twice the upper limit of normal, rarely {{c4::more than 10 times the upper limit of normal.}}
• {{c1::Chronic hepatitis B virus infection}}: Levels vary; the AST and ALT may be
normal in inactive carriers, whereas most patients with chronic hepatitis B have
mild to moderate elevations (approximately twice the upper limit of normal); with
exacerbations, levels are {{c4::more than 10 times the upper limit of normal}}