Mild ALT Elevation in Young Adult with Dizziness

Case at a Glance

A 23-year-old female presented with dizziness and was found to have mildly elevated ALT levels during routine laboratory workup, raising questions about liver function in a non-drinker.

Patient's Story

The patient, a 23-year-old female weighing approximately 190 pounds with fluctuating weight, presented to a new primary care physician with chief complaint of dizziness. She reported no significant alcohol consumption (less than 2 drinks monthly) and no family history of liver disease. Her medical history was notable for intermittent elevated cholesterol levels over the past two years. Current medications included Vyvanse 50mg taken four times weekly. She expressed concern about weight management, as advised by her physician due to concurrent dyslipidemia.

Initial Assessment

Physical examination findings were not detailed, but the patient appeared stable with primary concern being recent onset dizziness. Given the new symptom presentation, comprehensive laboratory workup was ordered to evaluate potential underlying causes and establish baseline values with the new healthcare provider.

The Diagnostic Journey

Laboratory results revealed ALT level of 39 U/L (mildly elevated above normal range), elevated white blood cell count, increased mean platelet volume (MPV), and elevated absolute neutrophil count. Cholesterol levels were confirmed to be elevated, consistent with previous findings. The constellation of findings suggested possible early viral syndrome or mild inflammatory process.

Final Diagnosis

Mild transaminase elevation, likely secondary to viral illness or early inflammatory process. Concurrent dyslipidemia and weight management issues were noted as ongoing concerns requiring monitoring.

Treatment Plan

Conservative management approach was recommended given the mild nature of ALT elevation. Follow-up liver function tests were scheduled in one month to monitor trend and determine if elevation represents beginning of progressive liver involvement or expected normalization. Weight management counseling was provided for concurrent dyslipidemia. Vyvanse therapy was continued as prescribed with monitoring.

Outcome and Follow-up

Patient was reassured about the mild nature of ALT elevation in isolation. Expert consultation confirmed that ALT of 39 U/L, while slightly elevated, does not warrant immediate aggressive investigation in absence of other concerning clinical or laboratory findings. Scheduled follow-up in 4 weeks for repeat liver enzymes and symptom assessment. Patient education provided regarding when to seek immediate care if symptoms worsen.