Unifying Concepts

Typical Laboratory Abnormalities in Alcoholic Liver Disease (ALD)

Alcoholic liver disease (ALD) encompasses a spectrum of injury, ranging from simple steatosis to frank cirrhosis.

Typical Laboratory Abnormalities in ALD
Serum enzymes

  • AST >>> ALT: Both usually <300 IU/L
  • Alkaline phosphatase (ALP) and g-glutamyl transpeptidase (GGT): Both usually elevated to a variable degree

Metabolic alterations

  • Hyperglycemia
  • Hypertrygleridemia
  • Hyperuricemia
  • Electrolyte abnormalities: low potassium, magnesium and phosphorus

Tests of liver function

  • Serum albumin, prothrombin time, and serum bilirubin usually normal until significant liver injury present

Hematological abnormalities

  • Mild anemia common (usually macrocytic)
  • Platelets (normal to markedly decreased)
  • Elevated white blood cell count: Leukemoid reactions associated with alcoholic hepatitis

Abbreviations: AST, aspartate aminotransferase;  ALT, alanine aminotransferase



  1. O’Shea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Am J Gastroenterol. 2010 Jan;105(1):14-32. [Medline]
  2. McCullough AJ, O’Connor JF. Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology. Am J Gastroenterol. 1998 Nov;93(11):2022-36. [Medline]


Created Sep 10, 2013.

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