“Give out with giblets”: this analysis will show that you drink too much alcohol

• Health

The narcologist told you what tests you need to pass in order to understand that you are clearly abusing alcohol. We are talking about four ordinary indicators and one specific.

October 12, 2022

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Many people believe that a few glasses of dry wine a day or a couple of bottles of beer after work will help to cheer up, relax and is easier to fall asleep. True, doctors have their own opinion on this matter, they warn that it is actually very easy to “cross the line” – regularly “relieving stress”, start abusing alcohol.

Dependence on alcohol develops quite quickly – a person does not notice how he starts drinking more and more. There are indirect signs that alcohol is already taking over you and you are turning from a moderate drinker into a drunkard. For example, for lovers of a foamy drink, there are signs that beer alcoholism is developing. For example, these symptoms will tell you that there is too much alcohol in your life.

Narcologists offer a more accurate method – to pass tests. What indicators in them “will give you away with giblets” and confirm that you are already abusing alcohol? Narcologist explains.

How to understand that a person drinks too much

— Narcologists are often asked this question, — admits narcologist Anna Odintsova. — One way to find out if a person is abusing alcohol is to undergo laboratory tests, take a clinical and biochemical blood test, and another specific test.

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5 important readings

– Normally, its value is 80-100 fL, but the numbers may vary slightly depending on the analyzer used in the laboratory, but the normal range will in any case be indicated on the form with the results analysis,” says Anna Odintsova.

In the biochemical blood test , three indicators can indicate alcohol abuse at once. They characterize the state of the liver:

• AST
  norm for men — up to 37 U/l,
  norm for women — up to 31 U/l.

• ALT

  norm in men — up to 40 U/l,

  norm in women — up to 35 U/l.

• GGT
  norm for men — 10-50 U/l,

  norm for women — 7-32 U/l.

The level of carbohydrate-deficient transferrin (CDT) speaks most precisely about alcohol abuse.

– This indicator is determined during professional medical examinations, when restoring a driver’s license that was withdrawn due to drunk driving. Normal serum CDT content does not exceed 1.2%. Regular alcohol consumption increases CDT levels by 10-15 times!

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It is important to evaluate in a complex

— Many alcohol abusers will have an excess in these five indicators, — sums up the narcologist. — And even if some of the indicators remain normal or close to it, they are are still evaluated in the complex. Each indicator individually may change in other diseases (except for CDT, it evaluates alcohol abuse), but in disputable cases, a consultation with a therapist, an additional specialist, is always prescribed.

The doctor draws attention to the fact that if the “alcohol” tests turn out to be very revealing, no one will force a person to stop drinking — there is no compulsory treatment for alcoholism in narcology. At most, doctors will recommend where and how to seek help.

As for how quickly bad tests can return to normal , the narcologist clarifies that this can only be said in each specific case.

– If you stop drinking, the CDT may decrease to normal within 3 months, other tests – up to 6 months or more. This is an individual process. It all depends on how long and in what volumes a person has been alcoholic. Plus – does a person receive rehabilitation treatment, – says Anna Odintsova.

Text author:Anna Maiskaya

How to interpret ALT, AST, Bilirubin, Alkaline Phosphatase

The American College of Gastroenterology (ACG) has released updated guidelines for blood chemistry tests used to assess liver health

New guidance is targeted at both professionals, as well as primary care physicians.

This document provides specific values ​​for the normal range of alanine aminotransferase (ALT) levels, as well as stepwise screening algorithms for elevations in ALT, aspartic aminotransferase (AST), alkaline phosphatase, and bilirubin. In comparison with the documents of previous editions, the new recommendations contain reduced limits of the norm. Those. previous recommendations have considered upper limit values ​​(URL) as the norm, which can vary significantly between laboratories, ranging from 30-40 international units (IU) per liter in some institutions and up to 70-80 IU/l in others. According to the new guidelines, the normal range for ALT will be 19-25 IU/L for women and 29-33 IU/L for men.

Cirrhosis of the liver. Questions and Answers

The authors noted that they are aware that, due to the decrease in the limits of the norm, many patients will fall into the category with elevated indicators and that this will create certain difficulties for doctors.

However, the authors consider the use of lower starting points justified, pointing out that sometimes even the smallest level of ALT elevation significantly increases the risk of death due to liver disease.

The authors point out that elevated ALT helps identify people with chronic liver diseases such as non-alcoholic fatty liver disease and chronic hepatitis C and B. over time, its level does not return to normal. The authors hope that, over time, practitioners will become accustomed to these new levels, and this will lead to improved liver health for all, as well as general health.

Key recommendations

1. Before starting to evaluate liver function abnormalities, repeat the laboratory panel and/or perform a clarifying test (eg, GGT test if serum alkaline phosphatase is elevated) to confirm that the blood chemistry for liver actually are not normal. (Strong recommendation, very low level of evidence).
2. Chronic hepatitis C testing is done with anti-HCV and confirmation is done with HCV RNA by nucleic acid testing. Risk factors for hepatitis C include a history of intranasal or intravenous drug use, tattoos, piercings, blood transfusions, and high-risk sexual behavior. Also at risk are people born between 1945 and 1965. Testing for acute hepatitis C is done with anti-HCV and HCV RNA by nucleic acid testing. (Strong recommendation, very low level of evidence).
3. Chronic hepatitis B testing is done with HBsAg testing. Testing for acute hepatitis B is associated with HBsAg and anti-HBc IgM.
   The following groups are most at risk: people born in endemic or hyperendemic areas (HBsAg prevalence > 2%), men who have sex with men, ever injecting drug users, dialysis patients, HIV-infected individuals, pregnant women and family members, family members and sexual contacts of HBV-infected persons. (Strong recommendation, very low level of evidence).
4. Testing for acute hepatitis A (IgM HAV) should occur in patients with acute hepatitis and suspected fecal-oral exposure. Acute hepatitis E (IgM HEV) testing should also be done in those returning from endemic areas who test negative for acute hepatitis A, B, and C. (Strong recommendation, very low level of evidence).
5. Patients with elevated BMI and other features of the metabolic syndrome, including diabetes mellitus, overweight or obesity, hyperlipidemia, or hypertension with mild ALT elevations, should undergo ultrasound screening for non-alcoholic fatty liver disease (NAFLD). (Strong recommendation, very low level of evidence).
6. Women consuming more than 140 g of alcohol per week or men consuming more than 210 g per week who have AST>ALT should be considered at risk for alcoholic liver disease and should be advised to stop drinking alcohol. (Strong recommendation, very low level of evidence).
7. All patients with abnormal liver function tests in the absence of acute hepatitis should be tested for hereditary hemochromatosis with iron, transferrin, and serum ferritin levels. HFE mutation analysis should be performed in patients with transferrin ≥45% and/or elevated serum ferritin. (Strong recommendation, very low level of evidence).
8. Patients with abnormal AST and ALT levels, especially those with other autoimmune conditions, should be tested for autoimmune liver disease including ANA, ASMA, and globulin levels. (Strong recommendation, very low level of evidence).
9. Patients with persistently elevated AST and ALT levels, especially those under 55 years of age, should be screened for Wilson’s disease with a serum ceruloplasmin test. If low ceruloplasmin is found, confirmatory testing with a 24-hour urine copper test and slit-lamp eye examination for abnormalities (Kaiser-Fleischer mosaic rings) is recommended. (Strong recommendation, very low level of evidence).
10. Patients with persistently elevated AST or ALT should be screened for alpha-1 antitrypsin deficiency (A1AT) with the alpha-1 antitrypsin phenotype. (Strong recommendation, very low level of evidence).
11. Doctors should ask patients with abnormal kidney tests about their medications and medications, including those they take on their own, without a doctor’s recommendation. It is also worth considering dietary or herbal supplements that may be associated with DILI. (Strong recommendation, very low level of evidence).
12. Liver biopsy may be considered when serological testing and imaging fail to reveal a diagnosis, interpret the condition, or when multiple diagnoses are possible. (Strong recommendation, very low level of evidence).
13. An increase in alkaline phosphatase should be confirmed by an increase in GGT. Given the lack of specificity for liver disease, GGT should not be used as a screening test for underlying liver disease in the absence of other abnormal liver findings. (Strong recommendation, very low level of evidence).
14. Patients with elevated alkaline phosphatase with or without elevated bilirubin should be tested for PBC (formerly called primary biliary cirrhosis) with anti-mitochondrial antibody testing. (Strong recommendation, very low level of evidence).
15. Patients with alkaline phosphatase elevation with or without bilirubin elevation should be tested for PSC by MR cholangiography or ERCP with IgG4. (Strong recommendation, very low level of evidence).
16. In patients with ALT and/or AST levels <5X ULN, laboratory investigations should evaluate the possibility of viral hepatitis B and C, alcoholic and NAFLD, hemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency, autoimmune hepatitis and consider the possibility of drug poisoning and associated with them liver damage. (Strong recommendation, very low level of evidence).
17. In individuals with an ALT and/or AST level of 5-15X ULN, acute hepatitis A, B, and C should be considered in addition to all etiologies. (Strong recommendation, very low level of evidence).
18. In individuals with ALT and/or AST levels > 15X ULN or massive ALT elevation > 10,000 IU/L, acetaminophen toxicity and ischemic hepatopathy (liver shock) should be considered. (Strong recommendation, very low level of evidence).
19. A patient with acute hepatitis with elevated prothrombin time and/or encephalopathy requires immediate referral to a hepaologist. liver specialist. (Strong recommendation, very low level of evidence).

ALT, alanine aminotransferase; ANA, antinuclear antibodies; ASMA, anti-smooth antibody; AST, aspartate aminotransferase; BMI, body mass index; DILI, drug-induced liver injury; GGT, gamma-glutamyl transferase; HAV, hepatitis A virus; HBc, hepatitis B major antigen; HBsAg, hepatitis B surface antigen; HCV, hepatitis C virus; HEV, hepatitis E virus; HFE, hereditary hemochromatosis; IgM, immunoglobulin M; MR, magnetic resonance; NAFLD, non-alcoholic fatty liver disease; PBC, primary biliary cholangitis; PSC, primary sclerosing cholangitis; ULN, upper limit of normal

Contributors to the guidelines:

Division of Gastroenterology/Hepatology, Department of Medicine, Stanford University School of Medicine Palo Alto, California, USA; Digestive Health Institute, University Hospitals Cleveland Medical Center and Division of Gastroenterology and Liver Disease, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Yale Viral Hepatitis Program, Yale University School of Medicine.