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1 yr old has elevated SGPT, SGOT. Obese, has fatty liver. What should be our next step ?

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Practicing since : 2005
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My one year old daughter has SGPT of 200 SGOT of 47, and alkaline phosphate just barely elevated. She had an ultrasound months ago and they suggest fatty liver as it was enlarged, with black and white spots. My daughter is considered obese as she is 32 pds and 32 inches tall. She also has a pineal cyst which they are following. My question is what do you believe the next step would be? She has had elevated liver labs basically since she was born but they have done no further testing then an ultrasound? How can her liver be getting worse when her weight hasn't increased in months?
Posted Wed, 18 Jul 2012 in Liver and Gall Bladder
Answered by Dr. Prasad 10 hours later

Thanks for the query.

Presuming her growth and development have been normal and she has no other major clinical symptoms apart from previous resolved renal tubular acidosis, obstructive sleep apnea / laryngomalacia, the cause of elevated liver enzyme and fatty liver is most likely to be related to being overweight.

Since the liver enzymes are elevated since birth, reduction of weight will only result in gradual decline of liver enzymes. So if I were to be her treating doctor, I would suggest the following:

1. Monitor her liver functions monthly for next 6 months to 1 year.
2. Plan to get a contrast enhanced computed tomography (CT) / magnetic resonance imaging (MRI) of abdomen.

If results are suspicious, I would refer her to a pediatric gastroenterologist. Evaluation to rule out congenital metabolic storage disorders is warranted.

Hope this answers your query. Let me know if you need any more information.

Above answer was peer-reviewed by
Follow-up: 1 yr old has elevated SGPT, SGOT. Obese, has fatty liver. What should be our next step ? 1 hour later
This is not the first time a metobolic disorder has been mentioned. We began keeping records after her fundoplication as to how much she ate and according to her endocrinologist she was only consuming 75 % of what she needed to, to maintain her weight. Currently she has not gained weight for about three months and is eating more normaly. We have had every blood test done to include genetic testing such as a micro-array. Some of her Drs. believe there is something seriously wrong with her while others believe her crazy labs may just be her. Her CPK is also elevated at 408 and her A/G ratio was elevated at 3.5. My question is what is the risk of damage to the liver with such elevations? My daughter was on 4 differnet anti-acids daily, for a month after she was born to try and control the GER, could they have damaged her liver? She was on metoclopramide, lansoprazole, ranitidine, and maalox. Thank you!
Answered by Dr. Prasad 3 hours later

Hi and thanks again,

I understand your daughter has been investigated extensively to determine a root cause. With the number of consultation you’ve had I am sure you’d have researched and had many opinions regarding your daughter’s problem.
I wish I had an opportunity to examine your daughter, review her developmental milestones and review all the investigation reports. With the limited information available, I would be difficult to predict possibilities; so I shall answer your queries specifically

1. The medications when prescribed in therapeutic doses are not known to cause liver dysfunction so as to cause such significant elevated liver enzymes; besides other biochemical dysfunction.

2. Liver enzymes are more useful to monitor the present status of liver disease. It has not much useful in determining the prognosis.
A preliminary contrast enhanced CT / MRI abdomen scan and liver biopsy would be essential to know the current status of liver and thereby predict the chances of reversal.

Hope this answers your query. Let me know if you need any more information.

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