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Q. What causes elevation of ALT levels without symptoms?

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Aug 03, 2020

Hello doctor,

My previous lab report showed ALT mildly elevated at 60, and I repeated in July, which showed ALT mildly elevated at 62. AST normal (28), alkaline phosphatase normal (77), total bilirubin normal (0.6). No known symptoms, normal BMI. What can be the cause?

Dr. Ajeet Kumar Lohana

Medical Gastroenterology


Welcome to

Well, first of all I need to know what was the reference level of the lab where this test perfomed. Because asymptomatic ALT (alanine transaminase) just above limit of the normal can completely be ignored and does not have a cause. Some medications like Tylenol, excessive exercise, higher than normal body temperature can cause this.

If the levels are 1.5 times the upper limit or twice to be precise, then this is a concern. Possible causes for such asymptomatic significant elevation of ALT can occur in various causes but notably in lean NAFLD (nonalcoholic fatty liver disease), drugs, chronic viral hepatitis, Wilson disease, and Alpha antitrypsin deficiency.

So it is important first to differentiate between abnormal lab result vs. just above the limit of normal value based on that lab reference. Athelets with good muscle mass, dehydration are other causes of asymptomatic nonsignifcant ALT elevation.

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