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Children's Health

Liver enzymes



what are normal liver enzymes for a four year old boy and what can cause the liver enzymes to be high


The recommended approach to testing is to order a liver profile rather than individual tests of liver function in order to get the most comprehensive evaluation likely to target the true disease process. A liver profile includes a total serum bilirubin and its direct fraction, alkaline phosphatase, serum protein and albumin levels, LD, AST, ALT, and GGT. The following are normal ranges for each test and the most common disease conditions affecting children associated with abnormal values:

Total serum bilirubin - 0.1-1.0 - increased in hepatitis and other rarer conditions

Direct bilirubin fraction - 0.1-0.3 - increased in liver disease, gall bladder disease, and liver tumors.

Alkaline phosphatase- 65-210, elevated in bone disease, if GGT and alkaline phosphatase are high, the problem is likely of origin in the liver such as a tumor or biliary obstruction; if elevated with ALT and AST, hepatitis is more likely.

Protein - 6.2-8.0 - decreases associated with malnutrition, liver disease, and immunoglobulin deficiencies.

Albumin - 4-5.9 - the same as for protein.

GGT (gamma glutamyl transferase) - 5-27 - increased in obstructive diease of the liver and gall bladder and in pancreatitis. If higher than AST and ALT elevated levels, then obstructive liver and gall bladder disease is very likely. ALT and AST will be higher than GGT elevations in hepatitis.

LD (lactate dehydrogenase) - 108-206 - increased levels associated with infectious mononucleosis, renal disease (higher levels than ALT and AST elevated levels), muscular dystrophy, liver tumors, and a wide variety of anemias.

ALT (alanine aminotransferase) - 5-35 - increased with hepatitis, gall bladder disease, biliary obstruction, and tumors of the liver.

AST (aspartate aminotransferase) - 8-20 - increased in liver disease and hepatitis, gall bladder disease, pancreatitis, and muscle injury.

The ratio of AST to ALT is useful also. If the ratio is greater than 1.0, liver congestion or liver tumor are more likely. If the ratio is less than 1.0, the problem is more likely hepatitis or mononucleosis.

Both AST and ALT are significantly increased in Reye's Syndrome, a condition requiring intensive care and most often following a viral illness treated with aspirin containing products.

AST, ALT, and LD elevated together suggests Duchenne's muscular dystrophy, a hereditary disease identified in boys during the early childhood years. 



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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University