What does inverted ALT/AST ratio in an occasional drinker indicate?

Posted on Mon, 8 Jun 2015 in Liver and Gall Bladder
Question: inverted ALT/AST.
I had been a heavy drinker for 25 years, a 44 year old female. last year we picked up fatty liver when my AST/ALT came back as 42 and 40 confirmed with an ultrasound. I reduced my drinking to maximum one unit per week, lost 7 kilos and 8 months later have had more ultrasound and CT scan where the appearance of the liver is normal. My LFTS are all in normal range but my AST/ALT remains inverted at 25/19.
everywhere on the internet it say this is a major red flag for seriously progressed liver damage.
However, my 19 year old daughter just had her LFTS, a very scarce drinker and also came back with AST/ ALT inversion at 24/17.
Should I be demanding a referral based on the ratio alone in absence of any other issues or evidence?
Is the one drink I have kept per week still too much following my history .
Answered by Dr. Heera Lal Poonia 1 hour later
Brief Answer:
inverted ratio is more important when enzyme levels are higher than normal

Detailed Answer:
Dear XXXXXXX welcome to HCM and thanks for choosing us.

I share your concerns about your liver enzyme ratio. I also appreciate your successful efforts to quit alcohol.

Let me first tell you that enzyme levels are always required to be studied with clinical symptoms and other investigations. Morever your enzyme levels are within normal range. Only the ratio is inverted . In my opinion ratio matters when enzymes levels are higher than normal. In that case it would indicate liver cirrhosis which is a complication of long term alcohol intake. But liver cirrhosis can be easily detected by ultrasound and ct scan, which in your case have come normal. You may wait for some more time. This ratio may also become normal. Or if you want a referral, you can request your doctor to remove your worries.
Regarding alcohol intake, once a week in limited quantity is not a big problem.

Take good care of yourself. I wish you good health. Best wishes.
Above answer was peer-reviewed by : Dr. Raju A.T
Answered by
Dr. Heera Lal Poonia

General & Family Physician

Practicing since :2008

Answered : 506 Questions


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