labs question

[realruby2000]

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I decided to post this here cuz i doubt it will get a serious answer in the lounge or everyone forum.

anyway i had some bloodwork done and everything pretty much came out ok. However, my AST was elevated to 43 (ALT 37). This is weird cuz i've never drank a drop of alcohol in my life or been infected with hep a b or c, or even take any meds for TB. I was expecting my AST/ALT to be nearly zero.

another thing is that serum creatinine was 1.2. I know thats normal but its kind of borderline isnt it? im 24 years old, male with a BMI a little over 23. I work out mabey once a week and run 2 miles twice a week.

Is this any thing to worry about? Whats goin on here????

 

[DrQuinn]

Remember that "normal" lab values are a result of thousands and thousands of seemingly disease free people getting a certain lab test performed. A certain %age of normal people will fall out of the "normal" range, such is the curse of averages.

I would follow up with your primary if you have any questions.

Q, DO

 

[Apollyon]

1. Your AST and ALT are BARELY up. You could have had Hep A, B, or C and not known it.

2. Creatinine is around 1 for most people; a big football player or lifter might have a creatinine near 2, and a tiny, little old lady might be at 0.5. Remember, creatinine is a marker of muscle turnover (and is completely secreted, which makes it a good indicator of kidney function). If you are a muscular young adult, with a 23 BMI, and exercising regularly, a Cr of 1.2 is COMPLETELY normal.

3. Quinn is right. It's averages.

Research this stuff - the information is right there, and it will put you at ease.

 

[realruby2000]

Originally posted by Apollyon
1. Your AST and ALT are BARELY up. You could have had Hep A, B, or C and not known it.

How can you have Hep and not know it? and even if you did have hep in the past, does that mean ur liver enzymes would still be up now??

 

[12R34Y]

5 million have HepC in U.S. and only 50,000 KNOW they have it.

This was in lecture last week in our liver path block from one of our path professors who specializes and researches liver stuff.

pretty scary

later

 

[DrQuinn]

Originally posted by 12R34Y
5 million have HepC in U.S. and only 50,000 KNOW they have it.

This was in lecture last week in our liver path block from one of our path professors who specializes and researches liver stuff.

pretty scary

later

aye-yai-yai... no need to scare the fella.

Best advice, talk to your primary about it... let them alleviate your fears. As you can see from these past 3-4 posts, it is entirely plausible that it is normal. But if you have doubts about anything, let your PCP know.

Q, DO

 

[Sessamoid]

That is clearly a normal value. I wouldn't even give it a second thought. When I see numbers like that, I chart "LFTs normal". Remember, the "normal ranges" are designed to include only about 95% (I think) of normals, the vast majority in the center of the bell curve. There will always be those normals that fall somewhat outside the 2 standard deviations.

 

[dry dre]

Originally posted by realruby2000
I work out mabey once a week and run 2 miles twice a week.

Is this any thing to worry about? Whats goin on here????

Were you well hydrated before the draw?

 

[realruby2000]

well since a FBG was also included in the exam, I didnt have anything to eat or drink the past 8 hours. How would that make a difference though?

 

[dread]

Originally posted by realruby2000
well since a FBG was also included in the exam, I didnt have anything to eat or drink the past 8 hours. How would that make a difference though?

Since you were volume contracted, that probably raised the value of your labs (creatinine, liver enzymes) as those values are a measure of concentration in your blood. So with less water, those values may be falsely elevated. I'd be interested in seeing the rest of your lab values (BUN in particular). With a creatinine of 1.2, I might want to see that followed up or at least I would have done a urinanalysis just in case. It's probably normal though, especially if you are a pretty muscular guy. And regarding hepatitis infections, primary infections of any of the hepatitis viruses can be asymptomatic or they can be misinterpreted as having the "flu" with generalized malaise and discomfort. I'm not saying that I think that you have a hepatitis virus, the liver enzymes you posted by themselves really aren't that concerning.

 

[realruby2000]

BUN = 16... I think. From what I remember though, it was well within the normal range. as for muscularity, im 5 foot 8 and 152lbs... im not fat, but i wont say im a bodybuilder either. I'm probably somewhere in the middle

 

[dread]

A high BUN to creatine ration (usually the criteria is 20:1) indicates that you were probably somewhat volume contracted during the blood draw. Anyways, I wouldn't worry about it too much. I'm certain that you will have your blood drawn in the future and you can compare your new value to the one you got this time.

 

[Eidolon6]

Your creatinine clearance is 92...your renal fxn is fine.

 

[beriberi]

A couple of things to think about when evaluating labs...

Why were they done? AST/ALT, BUN, Cr should not be drawn on a healthy person for screening of unknown diseases. Lots of right upper quadrant pain lately? Clay colored stools? Vomitting blood? Underlying chronic disease? Family member with congenital liver disease? Primary care doctor not aware of what tests are recommended in a healthy 20-something?

Second, as Quinn pointed out, most labs are normed so that out of a hundred healthy people 95 of them will have values within the normal range. Normals vary significantly from lab to lab--what are the normals at your lab? This also means that if you have a number of tests done--and are healthy--there is an increasing chance that you will have at least one abnormal result. (5% for one test, ~10% for two tests, ~14% for three, assuming that all tests measure independent variables). That is, don't order a CBC with diff and CMP on every patient. You won't like what you get.

As a favorite attending once said, "Ordering a lab is like picking your nose, you have to know what you are going to do with the result."


P.S. Estimations of Cr clearance from crokofft-gault (wt, Serum Cr and age) are a poor way to rule out kidney disease. Plus, many diseases have higher than avg. Cr clearance early in the course of the disease (DM and Sickle come to mind). Not that you have kidney disease.

 

[Apollyon]

Originally posted by beriberi
A couple of things to think about when evaluating labs...

Why were they done? AST/ALT, BUN, Cr should not be drawn on a healthy person for screening of unknown diseases. Lots of right upper quadrant pain lately? Clay colored stools? Vomitting blood? Underlying chronic disease? Family member with congenital liver disease? Primary care doctor not aware of what tests are recommended in a healthy 20-something?

The BUN/Cr is in the chem 7; an SMA-18 (comprehensive, whatever you call it) has the AST/ALT.

This guy is young and healthy. Either he's pulling our leg, or is unwilling to 1. ask his doctor or 2. search online or in a book for what this means.

 

[realruby2000]

Originally posted by beriberi
A couple of things to think about when evaluating labs...

Why were they done? AST/ALT, BUN, Cr should not be drawn on a healthy person for screening of unknown diseases. Lots of right upper quadrant pain lately? Clay colored stools? Vomitting blood? Underlying chronic disease? Family member with congenital liver disease? Primary care doctor not aware of what tests are recommended in a healthy 20-something?

Second, as Quinn pointed out, most labs are normed so that out of a hundred healthy people 95 of them will have values within the normal range. Normals vary significantly from lab to lab--what are the normals at your lab? This also means that if you have a number of tests done--and are healthy--there is an increasing chance that you will have at least one abnormal result. (5% for one test, ~10% for two tests, ~14% for three, assuming that all tests measure independent variables). That is, don't order a CBC with diff and CMP on every patient. You won't like what you get.

As a favorite attending once said, "Ordering a lab is like picking your nose, you have to know what you are going to do with the result."


P.S. Estimations of Cr clearance from crokofft-gault (wt, Serum Cr and age) are a poor way to rule out kidney disease. Plus, many diseases have higher than avg. Cr clearance early in the course of the disease (DM and Sickle come to mind). Not that you have kidney disease.

these tests were part of a workup for possible HTN. According to the new rules, my bp being in the upper 120's to mid 130's warrented these tests to be done. there are no GI symptoms at all so I dont know why AST/ALT were done.

 

[realruby2000]

Originally posted by Apollyon
The BUN/Cr is in the chem 7; an SMA-18 (comprehensive, whatever you call it) has the AST/ALT.

This guy is young and healthy. Either he's pulling our leg, or is unwilling to 1. ask his doctor or 2. search online or in a book for what this means.

I'm sorry buddy.... I am not pulling your leg, or anyone's. I have better stuff to do than post a made up story with fake numbers online. I havent talked to my FP yet because he's not going to be in the office for a while. I did an online search and I haven't learned anything new. I'm having trouble on finding info about young healthy males having elevated serum creatinine that are still within normal limits. anyways, i'll post up other values for the hell of it:

LDL 74.8
HDL 36.4
Total: 136 (Isn't Total HDL + LDL? I'm an M2 so pardon my ignorance)

Na 142
K 4.4

im sure there are other values but the nurse didnt tell them to me cuz i guess she assumed I wouldnt understand them. I guess I should have told her Im a medical student

 

[dry dre]

Originally posted by realruby2000
there are no GI symptoms at all so I dont know why AST/ALT were done.

Because you probably saw an internist.😀

Long live fleas!

 

[Apollyon]

Dude, you're doing fine. Your HDL is in the low normal range, so you need to exercise more (but, at the same time, your total chol of 136 is admirable - you don't have a lot to spread around).

A 20-something guy with a Cr of 1.2 doesn't even make my eyes widen.

Bottom line (from this doc, at least) - you're healthy.

 

[jashanley]

Originally posted by dry dre
Because you probably saw an internist.😀

What the hell does that mean?

I'm an internist and I don't "shot gun" healthy patients.

I know at the VA, some of the transaminases are actually included in a clin chem.

 

[margaritaboy]

I agree with the posts above. If you have concerns about your lab values, then talk to the your doctor about them. Preferably the one who ordered the labs to begin with.

 

[jpgreer13]

The statistics say if you order 20 lab values on any perfectly healthy individual, one of them will be abnormal simply because of how the ranges of normal are derived.