Alanine aminotransferase in clinical practice: a review

Article Abstract:

Measurement of alanine aminotransferase (ALT) is usually part of a full chemical profile, and is usually used in testing for non-A, non-B hepatitis. Because the test is so common, results outside the normal range are frequent, leaving the clinician with the decision of what to do about it. Many conditions can cause an increase in blood levels of ALT, including infections, drug and chemical poisoning (including alcohol), cancer, heart failure, systemic lupus erythematosus, injury, and obstruction of the bile tract. The ALT level does not indicate the diagnosis, but it is useful in determining certain conditions when the ratio to the enzyme aspartate aminotransferase (AST) is calculated. High ALT levels in healthy patients occur frequently on automated multiple chemistry profiles, and because cutoff points are arbitrary, they are problematic. High ALT levels are often caused by obesity or heavy alcohol consumption, and therapy would certainly benefit these patients. Among patients referred to a gastroenterologist (a specialist in digestive disorders), only about 20 percent have treatable disease, and the percentage is probably lower among patients seen in the average general practice. Evaluation of patients with a high ALT level should include a thorough medical history and physical examination. If nothing is found, measurement of ALT and other liver-associated enzymes should be repeated. If results are normal, nothing need be done. If other diseases are suspected, specific tests should be ordered. If the ALT remains high and no other disease is found, hepatitis and other screening tests are warranted. Continued high ALT levels imply chronic liver disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Liver diseases, Alanine aminotransferase

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The use of albumin in clinical practice

Article Abstract:

A review is presented of the medical literature concerning the clinical uses of albumin, a protein normally found in the blood. These include giving albumin as a supplement in transfusions for people with serious injuries or who are undergoing surgery. It may be administered until an optimal level in the blood is reached, or according to empirical formulas, to normalize hemodynamic variables such as arterial blood pressure. Albumin has also been used to treat patients with pulmonary insufficiency (a condition in which the lungs do not oxygenate the blood sufficiently); during open-heart surgery; for treating burn patients; and for treating patients with cirrhosis (a chronic liver disease) or nephrosis (a degenerative kidney disorder). Albumin has been administered as a nutritive supplement to patients undergoing enteral feeding (by means of a tube) or total parenteral nutrition (intravenous feeding). Other uses are also discussed. In summary, the clinical use of albumin is controversial; it is expensive but offers the advantage over blood products of not carrying viral contaminants. Albumin does not appear to be more effective than crystalloid solutions (which diffuse across membranes) as a transfusion agent in many circumstances, but it may be beneficial for the elderly who cannot be given the larger fluid volumes used for crystalloid solutions. More research is needed to compare the effectiveness of albumin with that of crystalloid solutions; the latter are relatively inexpensive. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Wounds and injuries, Wound care, Serum albumin, Albumin

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