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Dr. Andrew Rynne

Family Physician

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Quitted smoking. Test showed raised ALT, AST and bilirubin level. Worried for liver damage

Answered by
Dr. Charles S Narasi


Practicing since :1962

Answered : 693 Questions

Posted on Mon, 28 Jan 2013 in Liver and Gall Bladder
Question: I got my blood work done and I am little concern about the results. I am 35 years old I quit smoking about a month ago.

These are my results BEFORE a treatment with TRIMETHOPRIM-SULFAMETHOXAZOLE, 160-800 MG for 2 weeks:

SODIUM 139 135 - 145 mmol/L
POTASSIUM 4.5 3.5 - 5.0 mmol/L
CHLORIDE 102 98 - 107 mmol/L
CO2,TOTAL 23 21 - 31 mmol/L
ANION GAP 14 5 - 18
GLUCOSE 100 65 - 100 mg/dL
CALCIUM 10.3 8.5 - 10.5 mg/dL
BUN 12 8 - 25 mg/dL
CREATININE 0.96 0.72 - 1.25 mg/dL
BUN/CREAT RATIO 13 10 - 20
GFR if African American > 60 > 60 ml/min/1.73m2
GFR if not African American > 60 > 60 ml/min/1.73m2
ALBUMIN 4.6 3.8 - 5.0 g/dL
PROTEIN,TOTAL 8.1 6.0 - 8.0 g/dL
GLOBULIN 3.5 2.0 - 3.7 g/dL
A/G RATIO 1.3 1.0 - 2.0
BILIRUBIN,TOTAL 1.7 0.2 - 1.2 mg/dL
ALT (SGPT) 58 8 - 45 IU/L
AST (SGOT) 29 2 - 40 IU/L

And these are my results AFTER the 2 weeks treatment. I am very concern about some sort of liver damadge like chirosis . ALT AST level don't look that good
Can you please tell me your opinion on this
I forget about the AFTER 2 weeks treatment test results
ALBUMIN 4.7 3.8 - 5.0 g/dL
PROTEIN,TOTAL 8.0 6.0 - 8.0 g/dL
GLOBULIN 3.3 2.0 - 3.7 g/dL
A/G RATIO 1.4 1.0 - 2.0
BILIRUBIN,TOTAL 2.0 0.2 - 1.2 mg/dL
BILIRUBIN,DIRECT 0.5 0.1 - 0.5 mg/dL
BILIRUBIN,INDIRECT 1.5 0.2 - 0.8 mg/dL
ALT (SGPT) 105 8 - 45 IU/L
AST (SGOT) 43 2 - 40 IU/L

As I mentioned my ALT and AST lvl are high. So is the bilirubin
Answered by Dr. Charles S Narasi 2 hours later
First , I want to to reassure you that you don't have to
worry about the numbers. I know that you were treateted
for some infection with the sulfa combination. I assume it was
for a respiratory tract infection.
Regardless, the infection itself can make the liver enzyme to
be elevated. Also, there is a small incidence of side effects
from the drug itself that can make the enzymes to be elevated.
The Bilirubin elevation that you have is mainly indirect fraction
which is called unconjugated bilirubinemia which indicates
a little break down of red blood cells or hemolylis which is
seen with sulfa drugs. It is very mild and it will not cause severe
liver damage. The level of SGOT is only three units higher and is
within lab range. SGPT (ALT) usually is the last enzyme to come
down to normal after you have been off antibiotics or infection.
You can be sure that you will do fine without any liver damage.
I would recommend that you re-check your liver tests in about
4 weeks.
I wish you well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Charles S Narasi 51 minutes later
Thank you so much for the detailed answer . I was treated just 2 weeks for chronic prostatitis, although from what I have read the treatment for such a disease should have been for at least 6 weeks. Can you please comment if possible or suitable for your expertise ?

I do not know why my doctor choose to do these tests after the SULFAMETHOXAZOLE treatment ..
So you would say at this point I should not be worried about fatty liver or cirrhosis ??
Thank you so much for your reply
Answered by Dr. Charles S Narasi 9 hours later
Thank you for your kind comments. The length of treatment depends
on thhow severe the infection is. In most cases two weeks of therapy
will be adquate unless you are having recurrent symptoms.
I would not worry about Fatty liver or Cirrhosis in your case. The
liver enzymes will get back to normal in time.
I wish you well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Charles S Narasi 3 hours later
Thank you doctor for such good answer.
My doctor just told me that the SULFAMETHOXAZOLE treatment can not increase the ALT lvl and now he wants to have me do a ultrasound scan. I do not understand. Everywhere I asked TRIMETHOPRIM- SULFAMETHOXAZOLE is known to increase ALT leves. My doctor is the only one that doesn't believe this. He has already done a HBV and HCV and those were negative. I really do not know what to think. He told me that I have D vitamin deficiency and high cholesterol.
Can you please tell me what is your opinion on all this ?
Thank you so much . This is my last question to you.
Answered by Dr. Charles S Narasi 1 hour later
I am glad that your Hepatitis screening was negative.
Regardless of your doctor's personal opinion, we do
see occasional effect of the liver enzymes. Did he check
your vitamin-D levels in the blood ? If you have high
cholesterol and you are really overweight , then you should
work on it for sure. Ultrasound of the liver and gallbladder
may be worthwhile getting to rule out gallstones and to see
if you have early fatty changes. Again, I want to assure you
that this will not turn into cirrhosis.
I wish you well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Charles S Narasi 21 minutes later
Yes my doctor checked for D vitamin level and is low 13.7 . He gave me RGOCALCIFEROL (VITAMIN D) 50,000 UNIT CAPSULE. That scared me as well ...

My HDL 40
LDL 179
Triglyceride 219
Total 263
I am not overweigtht. I am 5.6 " with 168lb. (or maybe I am ) Can you please please comment on these new data ?
Thank you so much . Looking forward for your remarks
Answered by Dr. Charles S Narasi 50 minutes later
Your triglyceride and LDL levels are high.HDL is low normal
You can follow a low cholesterol diet and recheck levels in
3-6 months and the numbers come down, you may not need
medications.You could also start taking Fish oil capsule- Omega
3-fatty acid(1200 mg/daily.The other one is Co-Enzyme Q .
Try these and goopd luck.
Calcium supplement is O.K. to take.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Charles S Narasi 22 minutes later
Doctor thank you again for your answer .
Last question Why did you ask about D vitamin lvl ? What are the implications of this ?

Thank you
with great respect
Answered by Dr. Charles S Narasi 9 minutes later
I just wanted to be sure that the deficiency was diagnosed
accurately with blood level. Some doctors , just guess and
try to treat. Too much Vit-D is bad for the liver. You will be O.K.
Wish you well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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