serum glutamic pyruvic transaminase

Alanine Aminotransferase

Common use

Specimen

Normal findings

Description

This procedure is contraindicated for

N/A

Indications

• Compare serially with aspartate aminotransferase (AST) levels to track the course of liver disease
• Monitor liver damage resulting from hepatotoxic drugs
• Monitor response to treatment of liver disease, with tissue repair indicated by gradually declining levels

Potential diagnosis

Increased in

• Related to release of ALT from damaged liver, kidney, heart, pancreas, red blood cells, or skeletal muscle cells.

• Acute pancreatitis
• AIDS (related to hepatitis B co-infection)
• Biliary tract obstruction
• Burns (severe)
• Chronic alcohol abuse
• Cirrhosis
• Fatty liver
• Hepatic carcinoma
• Hepatitis
• Infectious mononucleosis
• Muscle injury from intramuscular injections, trauma, infection, and seizures (recent)
• Muscular dystrophy
• Myocardial infarction
• Myositis
• Pancreatitis
• Pre-eclampsia
• Shock (severe)

Decreased in

Pyridoxal phosphate deficiency (related to a deficiency of pyridoxal phosphate that results in decreased production of ALT)

Critical findings

N/A

Interfering factors

• Drugs that may increase ALT levels by causing cholestasis include anabolic steroids, dapsone, estrogens, ethionamide, icterogenin, mepazine, methandriol, oral contraceptives, oxymetholone, propoxyphene, sulfonylureas, and zidovudine.
• Drugs that may increase ALT levels by causing hepatocellular damage include acetaminophen (toxic), acetylsalicylic acid, anticonvulsants, asparaginase, carbutamide, cephalosporins, chloramphenicol, clofibrate, cytarabine, danazol, dinitrophenol, enflurane, erythromycin, ethambutol, ethionamide, ethotoin, florantyrone, foscarnet, gentamicin, gold salts, halothane, ibufenac, indomethacin, interleukin-2, isoniazid, lincomycin, low-molecular-weight heparin, metahexamide, metaxalone, methoxsalen, methyldopa, methylthiouracil, naproxen, nitrofurans, oral contraceptives, probenecid, procainamide, and tetracyclines.
• Drugs that may decrease ALT levels include cyclosporine, interferons, metronidazole (affects enzymatic test methods), and ursodiol.

Nursing Implications and Procedure

Potential nursing problems

Pretest

• Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
• Patient Teaching: Inform the patient this test can assist with evaluation of liver function and help identify disease.
• Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
• Obtain a history of the patient’s hepatobiliary system, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
• Obtain a list of the patient’s current medications including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values).
• Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
• Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
• Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

• Potential complications: N/A
• Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
• Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
• Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
• Remove the needle, and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding and hematoma formation and secure gauze with adhesive bandage.
• Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

• Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
• Nutritional Considerations: Increased ALT levels may be associated with liver disease. Dietary recommendations may be indicated and vary depending on the severity of the condition. A low-protein diet may be in order if the patient’s liver has lost the ability to process the end products of protein metabolism. A diet of soft foods may be required if esophageal varices have developed. Ammonia levels may be used to determine whether protein should be added to or reduced from the diet. Patients should be encouraged to eat simple carbohydrates and emulsified fats (as in homogenized milk or eggs) rather than complex carbohydrates (e.g., starch, fiber, and glycogen [animal carbohydrates]) and complex fats, which require additional bile to emulsify them so that they can be used. The cirrhotic patient should be carefully observed for the development of ascites, in which case fluid and electrolyte balance requires strict attention.
• Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

• Patient Education

  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Recognize anxiety related to test results, and answer any questions or address any concerns voiced by the patient or family.
  • Provide teaching and information regarding the clinical implications of the test results, as appropriate.
  • Educate the patient regarding access to counseling services. Provide contact information, if desired, for the Centers for Disease Control and Prevention (www.cdc.gov/diseasesconditions).
  • Provide information regarding disease process and proactive activities that the patient can take in managing health.
  • Provide samples of dietary selections that can support pancreatic and liver health and that are culturally appropriate.

• Expected Patient Outcomes

  • Knowledge
  • The patient and family verbalize understanding of causative factors of pancreatitis and liver disease.
  • The patient and family verbalize understanding that the disease can reoccur if not adhering to positive actions to change lifestyle.
  • Skills
  • The patient creates a diet plan that supports liver and pancreatic health.
  • The patient takes medication as prescribed to limit pancreatic secretions and decrease pain.
  • Attitude
  • The patient agrees to seek counseling for alcohol abstinence.
  • The patient agrees to control potential behaviors that could trigger future disease episodes.

Related Monographs

• Related tests include acetaminophen, ammonia, AST, bilirubin, biopsy liver, cholangiography percutaneous transhepatic, electrolytes, GGT, hepatitis antigens and antibodies, LDH, liver and spleen scan, US abdomen, and US liver.
• See the Hepatobiliary System table at the end of the book for related tests by body system.