Liver Function Testing (LFT) 18 December 1998
I'm still trying to break off working on the Tasmar safety
issue, but of course it's still "breaking news" and I feel
obliged to keep reporting. Most recently you saw a letter from
Dr. S. Fahn on the position of the PDF. I sent a personal reply
with a couple of questions, that I hoped would reach him today,
but my PC blundered again and I had to re-send it. The subject
of liver enzyme monitoring is confusing to say the least, so
here is a (very) little clarification:
The blood tests recommended are for levels of two enzymes that
are like distress signals of the liver. Their names were changed
8 or 10 years ago, but not all the doctors are on board as yet:
OLD NEW
Serum Glutamic-Pyruvic Alanine Aminotransferase (ALT)
Transaminase (SGPT)
Serum Glutamic-Oxaloacetic Aspartate Aminotransferase (AST)
Transaminase (SGOT)
On its printed lab forms, Kaiser uses both, just to be sure.
The unit of measurement has also changed. I can't print the
mathematical form here, but the new units are 1/17 as large
as the old ones. The latest (1992) edition of the Merck Manual
is a bit dated but it has a table showing the "Reference Range"
which in all current journals is referred to as the "normal"
or disease-free range, in each system of units. The Kaiser lab
report form, however, cites their own set of numerical values.
All the current articles I've seen use the new, or Systeme
Internationale (SI) units, but Kaiser apparently uses the old
ones, which they call International Units (IU). The diagnostic
criterion, Upper Limit of Normal (ULN) appears in all current
articles. For ALT, the more significant test, up to 3 times
ULN used to be considered OK, but the new recommendation is
to stop Tasmar if ALT exceeds ULN by any amount.
REFERENCE RANGE
MEASURED CONVENTIONAL SI KAISER
AST or SGOT 7-27 117-450 9-30
ALT or SGPT 1-21 17-350 5-35
When I asked for the result of my two ALT tests, the Kaiser
neurology nurse said "5; normal", but couldn't elaborate
further. I hope that this makes everything clear. Cheers,
Joe
--
J. R. Bruman (818) 789-3694
3527 Cody Road
Sherman Oaks, CA 91403-5013
