Elevated liver enzymes and triglyceride levels. What's it mean?
August 9, 2019 1:22 PM   Subscribe

YANMD. I was planning to start on Accutane this week but before I could do this I had to take a blood test showing my liver enzymes and triglycerides were at normal levels. My results came back and the numbers were higher than they should be, so the doctor had me do another set of labs. The numbers were still elevated.

Some details: I’m a 35 year old male. I’m a bit overweight but not much. I probably eat too much sugar and not enough vegetables, and I haven’t exercised regularly in about two months. In April I had a physical and my ALT was 16, my AST was 20 and I don’t have my triglyceride results. My second test from last week was ALT at 92 , AST at 66, and triglycerides at 298. Do these results/the difference in numbers make any sense in that timespan? Does this indicate anything very serious? The dermatologist’s office just told me they’d fax over the labs to my primary care doctor and I should schedule an appointment with him.

I tried to get an appointment at my employers health clinic for today but their systems were down, and then my primary care physicians office was switching to a new system so they told me they’re not scheduling appointments again until Tuesday. In the meantime, I’m just kind of wondering what this might mean, how concerned I should be, what steps I should take, if any, between now and getting in to see someone at either of these offices? Thanks for any help or insight into this!
posted by rbf1138 to Health & Fitness (6 answers total) 1 user marked this as a favorite
If there were anything to be immediately concerned about, your dermatologist's office would have said so.

Just call up your PCP on Monday and let them know you have questions about your blood work.
posted by tivalasvegas at 2:01 PM on August 9

There are a million reasons that your results differ between these two time points, and 99% of them are benign. It may be as simple as a lab testing error. You'll probably be asked to get the tests done again. Two sets of data points aren't enough to make decisions from, and that's probably what your doctor will tell you.
posted by late afternoon dreaming hotel at 2:01 PM on August 9

Those would be markedly elevated but not acutely dangerous and that dramatic of a change seems fairly aberrant. They'll want to do a repeat to make sure they didn't publish the wrong results.
posted by sibboleth at 2:05 PM on August 9

I don't think you need to worry too much right now. The ALT and AST lab results are mildly elevated and a mild increase is definitely possible within 4 months. This type of increase is something I would make sure to ask your Doctor about at your next visit. It's not someting to go to the Emergency Room for.

It's usually recommended that patients fast for 12 hours for cholesterol/triglyceride testing. The triglyceride result can be elevated if a patient recently ate. Triglyceride results are standardized on fasting patients so if you're non-fasting your result can look artificially higher.

Healthy eating and exercise can help lower your triglycerides. Simple carbohydrates and sugar can definitely increase your triglycerides. Try to eat more whole grains, vegetables, and other foods high in fiber as well as increasing the time you spend exercising. Simple things like walking can help lower your triglycerides. Cutting back on alcohol can also lower your triglycerides.
posted by mundo at 2:59 PM on August 9

Your primary will probably suggest you repeat the tests again, and refrain from any alcohol or Tylenol for a week or so before having the tests. You will be asked about any other medications, weight loss substances, herbal products and vitamins you have taken recently. Health-food store teas or powders also qualify and should be disclosed, and it would be a good idea to take the bottles or boxes with you to the office.

Everything we eat, drink or otherwise absorb is processed through the liver, and many substances can cause abnormal enzymes. Many things taken in modest amounts - alcohol, Tylenol, vitamins - can cause severe damage in large amounts. As a hepatology (liver) nurse I saw several cases of liver damage caused by ingestion of large quantities of vitamin A, for example. In one case the patient's ALT was in the thousands, but it took a careful history to discern that the patient was taking massive amounts of megavitamins, including vitamin A, which is fat soluble and not well excreted. The patient had a hard time believing a "natural" substance could cause him harm. Not trying to scare you - this case was quite extreme - only to emphasize that elevated enzymes are pretty common, there can be many reasons, and surprising substances can be the cause.

Your doc might also order some basic tests for other causes of liver inflammation - that's what the elevated enzymes represent - like hepatitis A, B, and C, all tests that are not routinely done but can also cause liver enzyme elevations, though I've never known hepatitis to raise triglycerides. The doc may want to simply rule infection out. You may be asked about recent travel to places where infections are more common as well. Cholesterol/triglyceride testing should be done fasting for the most accurate result.

You say your enzymes and triglycerides rose together in this recent testing, and this suggests something has affected both. Your enzymes, while high, are in no way an emergency. Your doctor needs to take a thorough history to help figure this out, and may suggest a consultation with a specialist if the numbers continue to rise or don't drop back. Best of luck.
posted by citygirl at 3:13 PM on August 9 [6 favorites]

Citygirl has it. The vitamin A story is very relevant because Accutane is basically mega-vit A.

Here is a reasonably readable overview of what goes through a PCP's brain when they see mild elevations in AST and ALT in an asymptomatic patient. As you can see, unless you are clinically jaundiced or your liver enzymes are up in the thousands, this is not emergent. If your eyes start turning yellow, though, get thee to urgent care.

Pro-tip: Bring a copy of your labs to your office visit; don't trust the dermatologist's fax to get to your PCP unless they work in the same health system and share an electronic medical record.
posted by basalganglia at 4:26 AM on August 10 [1 favorite]

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