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Alanine Aminotransferase


ALT, SGPT (serum glutamic pyruvic transaminase).

Common Use:
To assess liver function related to liver disease and/or damage.

Serum collected in a gold-, red-, or red/gray-top tube. Plasma collected in a green-top (heparin) tube is also acceptable.

Normal Findings:
(Method: Spectrophotometry)

AgeConventional & SI Units
Newborn–12 mo7–41 units/L
13 mo–60 yr
 Male19–36 units/L
 Female24–36 units/L
61–90 yr
 Male13–40 units/L
 Female10–28 units/L
Greater than 90 yr
 Male6–38 units/L
 Female5–24 units/L
Values may be slightly elevated in older adults due to the effects of medications and the presence of multiple chronic or acute diseases with or without muted symptoms.


Alanine aminotransferase (ALT) is an enzyme produced by the liver. The highest concentration of ALT is found in liver cells; moderate amounts are found in kidney cells; and smaller amounts are found in heart, pancreas, spleen, skeletal muscle, and red blood cells. When liver damage occurs, serum levels of ALT may increase as much as 50 times normal, making this a sensitive test for evaluating liver function. ALT is part of a group of tests known as LFTs, or liver function tests, used to evaluate liver function: ALT; albumin; alkaline phosphatase; aspartate aminotransferase (AST); bilirubin, direct; bilirubin, total; and protein, total.

This procedure is contraindicated for



  • Compare serially with 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 misuse
  • Cirrhosis
  • Fatty liver
  • HELLP syndrome of pregnancy (hemolysis, elevated liver enzymes, low platelet count)
  • 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


Interfering Factors

  • Drugs and other substances that may increase ALT levels by causing cholestasis include anabolic steroids, dapsone, estrogens, ethionamide, oral contraceptives, sulfonylureas, and zidovudine
  • Drugs and other substances that may increase ALT levels by causing hepatocellular damage include acetaminophen (toxic), acetylsalicylic acid, anticonvulsants, asparaginase, cephalosporins, chloramphenicol, clofibrate, cytarabine, danazol, 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, naproxen, nitrofurans, oral contraceptives, probenecid, procainamide, and tetracyclines
  • Drugs and other substances that may decrease ALT levels include cyclosporine, interferons, metronidazole (affects enzymatic test methods), and ursodiol

Nursing Implications Procedure

Related Studies

  • 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 online at DavisPlus for related tests by body system.

Potential Nursing Problems

ProblemSigns & SymptomsInterventions
Pain (related to organ inflammation and surrounding tissues; excessive alcohol intake; infection)Emotional symptoms of distress; crying; agitation; facial grimace; moaning; verbalization of pain; rocking motions; irritability; disturbed sleep; diaphoresis; altered blood pressure and heart rate; nausea; vomiting; self-report of pain; upper abdominal and gastric pain after eating fatty foods or alcohol intake with acute pancreatic disease; pain, which may be decreased or absent in chronic pancreatic diseaseCollaborate with the patient and health-care provider (HCP) to identify the best pain management modality to provide relief; refrain from activities that may aggravate pain; use the application of heat or cold to the best effect in managing pain; monitor pain severity
Fluid volume (water) (related to vomiting; decreased intake; compromised kidney function; overly aggressive fluid resuscitation; overly aggressive diuresis)Overload: Edema, shortness of breath, increased weight, ascites, rales, rhonchi, and diluted laboratory values. Deficient: Decreased urinary output, fatigue, and sunken eyes, dark urine, decreased blood pressure, increased heart rate, and altered mental statusComplete a daily weight with monitoring of trends; accurate intake and output; collaborate with HCP regarding administration of intravenous (IV) fluids to support hydration; monitor laboratory values that reflect alterations in fluid status (potassium, blood urea nitrogen, creatinine, calcium, hemoglobin, and hematocrit); manage underlying cause of fluid alteration; monitor urine characteristics and respiratory status; establish baseline assessment data; collaborate with HCP to adjust oral and IV fluids to provide optimal hydration status; administer replacement electrolytes, as ordered
Nutrition (related to metabolic imbalances)Increased liver function tests; hyperglycemia with polyuria, weight loss, weakness, nausea, vomiting; hypocalcemia with confusion, intestinal cramping, diarrhea; hypertriglyceridemia; altered thiamine with weakness, confusionAdminister enteral nutrition; administer parenteral nutrition; monitor laboratory values and collaborate with HCP on replacement strategies; correlate laboratory values with IV fluid infusion and collaborate with the HCP and pharmacist to adjust to patient needs; ensure adequate pain control; monitor vital signs for alterations associated metabolic imbalances
Gastrointestinal (GI) problems (related to altered motility; irritation of the GI tract; taste alterations; pancreatic and gastric secretions)Nausea; vomiting; abdominal distention; unexplained weight loss; steatorrhea; diarrhea; visible abdominal distention; ascites; diminished or absent bowel soundsPerform nasogastric intubation (NGT) to remove gastric secretions and decrease pancreatic secretions, which may result in autodigestion; monitor NGT for patency and amount of drainage; assess hydration status; assess bowel sounds frequently; measure abdominal girth to monitor degree of abdominal distention


  • Positively identify the patient using at least two person-specific identifiers before services, treatments, or procedures are performed.
  • Patient Teaching: Inform the patient this test can assist with evaluation of liver function and help identify liver disease.
  • Obtain a history of the patient’s health concerns, symptoms, surgical procedures, and results of previously performed laboratory and diagnostic studies. Include a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a list of the patient’s current medications, including over-the-counter medications and dietary supplements (see Effects of Dietary Supplements online at DavisPlus).
  • 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.


Potential Complications:

  • 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 online at DavisPlus. 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 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:


  • The patient and family verbalize causative factors of pancreatitis and liver disease.
  • The patient and family verbalize that the disease can reoccur if not adhering to positive actions to change lifestyle.

  • 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.

  • The patient agrees to seek counseling for alcohol abstinence.
  • The patient agrees to control potential behaviors that could trigger future disease episodes.

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Bladh, Mickey Lynn., and Anne M. Van Leeuwen. "Alanine Aminotransferase." Davis's Lab & Diagnostic Tests, 7th ed., F.A. Davis Company, 2017. Nursing Central, nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425050/all/Alanine_Aminotransferase.
Bladh ML, Van Leeuwen AM. Alanine Aminotransferase. Davis's Lab & Diagnostic Tests. 7th ed. F.A. Davis Company; 2017. https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425050/all/Alanine_Aminotransferase. Accessed April 21, 2019.
Bladh, M. L., & Van Leeuwen, A. M. (2017). Alanine Aminotransferase. In Davis's Lab & Diagnostic Tests. Available from https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425050/all/Alanine_Aminotransferase
Bladh ML, Van Leeuwen AM. Alanine Aminotransferase [Internet]. In: Davis's Lab & Diagnostic Tests. F.A. Davis Company; 2017. [cited 2019 April 21]. Available from: https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425050/all/Alanine_Aminotransferase.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Alanine Aminotransferase ID - 425050 A1 - Bladh,Mickey Lynn, AU - Van Leeuwen,Anne M, BT - Davis's Laboratory & Diagnostic Tests UR - https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425050/all/Alanine_Aminotransferase PB - F.A. Davis Company ET - 7 DB - Nursing Central DP - Unbound Medicine ER -