Considered an indicator of cellular damage in liver disease, such as hepatitis or cirrhosis.
There are no food, fluid, activity, or medication restrictions unless by medical direction.
Method: Spectrophotometry, enzymatic.
|Age||Conventional and SI Units||SI Units Expressed as microkat/L = (Units/L × 0.017)|
|Newborn||25–75 units/L||0.43–1.28 microkat/L|
|10 days–3 yr||15–60 units/L||0.26–1.02 microkat/L|
|Child||20–39 units/L||0.34–0.66 microkat/L|
|Male||20–40 units/L||0.34–0.68 microkat/L|
|Female||15–30 units/L||0.26–0.51 microkat/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.|
Critical Findings and Potential Interventions
Overview(Study type: Blood collected in a gold-, red-, or red/gray-top tube; related body system: Digestive system.) Aspartate aminotransferase (AST) is an enzyme that catalyzes the reversible transfer of an amino group between aspartate and α-ketoglutaric acid in the citric acid or Krebs cycle, a powerful and essential biochemical pathway for releasing stored energy. AST exists in large amounts in liver and myocardial cells and in smaller but significant amounts in skeletal muscle, kidneys, pancreas, red blood cells, and the brain.
Serum AST rises when there is damage to the tissues and cells where the enzyme is found, and levels directly reflect the extent of damage. AST values greater than 500 units/L (SI = 8.5 microkat/L) are usually associated with hepatitis and other hepatocellular diseases in an acute phase. AST levels are very elevated at birth, decrease with age to adulthood, and increase slightly in older adults.
- Compare serially with alanine aminotransferase levels to track the course of hepatitis.
- Monitor response to therapy with potentially hepatotoxic or nephrotoxic drugs.
- Monitor response to treatment for various disorders of hepatic function in which AST may be elevated, with tissue repair indicated by declining levels.
Factors that may alter the results of the study
- Drugs and other substances that may increase AST levels include acarbose, ACE inhibitors, acetaminophen (toxic), acetylsalicylic acid, allopurinol, amoxicillin, amiodarone, ampicillin, amytriptyline, ARBs, asparaginase, azathioprine, β-blockers, baclofen, bupropion, carbamazepine, cephalosporins, chloramphenicol, chlordiazepoxide, chlorpromazine, chlorpropamide, clindamycin, cloxacillin, clopidogrel, codeine, cyproheptadine, cytarabine, danazol, desipramine, dicumarol, doxepin, enflurane, erythromycin, estrogens, ethambutol, ethionamide, ethotoin, ethyl alcohol, fibrates, gentamicin, gold salts, imipramine, isoniazid, ketoconazole, low-molecular-weight heparin, methyl dopa, metaxalone, methotrexate, nafcillin, naladixic acid, nitrofurans, nortriptyline, NSAIDs, omeprazole, oral contraceptives, oxacillin, phenobarbital, phenytoin, probenecid, procainamide, propoxyphene, pyrazinamide, quinidine, rifampin, risperidone, sulfonamides, terbinafine, tetracyclines, trazadone, trimethoprim, valproic acid, verapamil, and zidovudine.
- Hemolyzed specimens may cause falsely elevated results.
- Hemodialysis decreases AST values.
Potential Medical Diagnosis: Clinical Significance of Results
AST is released from any damaged cell in which it is stored, so conditions that affect the liver, kidneys, heart, pancreas, red blood cells, or skeletal muscle and cause cellular destruction demonstrate elevated AST levels.
Significantly increased (greater than five times normal levels) in:
- Acute hepatitis (AST is very elevated in acute viral hepatitis)
- Acute hepatocellular disease (especially related to chemical toxicity or drug overdose; moderate doses of acetaminophen have initiated severe hepatocellular disease in patients who are alcoholics)
- Acute pancreatitis
Moderately increased (three to five times normal levels) in:
- Alcohol misuse (chronic)
- Biliary tract obstruction
- Cardiac dysrhythmias
- Cardiac catheterization, angioplasty, or surgery
- Chronic hepatitis
- Heart failure
- HELLP syndrome of pregnancy; variant of pre-eclampsia (hemolysis, elevated liver enzymes, low platelet count)
- Infectious mononucleosis
- Liver tumors
- Muscle diseases (e.g., dermatomyositis, dystrophy, gangrene, polymyositis, trichinosis)
- Myocardial infarction
- Reye syndrome
- Trauma (related to injury or surgery of liver, head, and other sites where AST is found)
Slightly increased (two to three times normal) in:
- Cerebrovascular accident
- Cirrhosis, fatty liver (related to obesity, diabetes, jejunoileal bypass, administration of total parenteral nutrition)
- Delirium tremens
- Hemolytic anemia
- Pulmonary infarction
- Hemodialysis (presumed to be related to a corresponding deficiency of vitamin B6 observed in hemodialysis patients)
- Uremia (related to a buildup of toxins that modify the activity of coenzymes required for transaminase activity)
- Vitamin B6 deficiency (related to the lack of vitamin B6, a required cofactor for the transaminases)
Before the Study: Planning and Implementation
Teaching the Patient What to Expect
- Inform the patient this test can assist in assessing liver function.
- Explain that a blood sample is needed for the test.
Potential Nursing Actions
- Measuring and trending abdominal girth can assist in monitoring the progression of ascites with liver disease.
After the Study: Potential Nursing Actions
- The patient with cirrhosis should be observed carefully for the development of ascites, in which case fluid and electrolyte balance requires strict attention.
- Increased AST levels may be associated with liver disease. In general, patients should be encouraged to eat a well-balanced diet that includes foods high in fiber. Dietary recommendations will vary depending on the condition and its severity. For example, recommend a diet of soft foods if esophageal varices develop, fat substitutes for bile duct disease, or limitations on salt intake if ascites develop.
- Alternative nutrition replacement options include enteral and parenteral nutrition.
- Correlate laboratory values with IV fluid infusion and collaborate with the health-care provider and pharmacist to adjust enteral and parenteral nutrition to patient caloric needs.
- Facilitate adequate pain and nausea control to improve caloric intake.
- Diet may need to be supplemented with vitamins and folic acid.
Followup Evaluation and Desired Outcomes
- Those patients with alcohol misuse as a causal factor in disease development agree to cease drinking.
- Seeks support from family, community, faith-based, or medical professional to assist in remaining free from alcohol abuse and maintenance of positive lifestyle changes.
- Patient and family are aware of the importance of reporting respiratory infection, bleeding, skin breakdown, changes in personality, increasing stupor, or lethargy to the HCP.
- Seeks psychological counseling to address, fear, anxiety, or depression associated with diagnosis and prognosis.
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