Q: I am a 44 years old man. My ALT/SGPT level is 108. I have tested negative for hepatitis. My liver test came back normal for everything except the ALT/SGPT level. I am planning another trip to the doctor, but would like to be armed with as much information as possible. If you have any ideas as to what might be causing the increased levels?

A:The work-up of high ALT is in the following order: 1. Repeat the test after 6 months. If still high do the following: 2. Anti-HCV and HBsAg tests; if negative: 3. Serum iron, TIBC and ferritin; if negative 4. Serum ANA 5. Liver ultrasound. If all tests are negative, the most likely diagnosis is fatty liver. The causes of which are: 1. Excessive alcohol use 2. Overweight 3. Diabetes 4. High serum lipid (fat) levels.