### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
My daughter is suffering from eating disorder (restricting calories). she is presently in a behavorial facility. Her Alt And AST keep fluating. They have been abnormal since the end of April. I am concerned these levels are not going back to normal. We have been told that it is normal for them to flucuate but we are concerned. She is asymptomatic. My question is why do they fluate and how long does it take for them to normalize. Another bit of information is she had completely normal labs in Feburary .

### output:

Hi, I had gone through your question and understand your concerns. Firstly, I must stress that one or a few of the liver function tests should not be interpreted in isolation. The entire hepatic function panel should be ideally be available along with the normal laboratory reference ranges for a meaningful interpretation. You have provided only the AST and ALT values. Therefore, I can only answer in general terms. Serum aminotransferases: are of two types.- alpine aminotransferase (ALT) and- aspartame aminotransferase (AST). Elevations of these are the two of the most useful indicators of liver cell injury. The AST is less live specific than the ALT. Elevations of the AST level may also be seen in acute muscle injury, (cardiac or skeletal muscle). Mild degrees of ALT level elevation may occasionally be seen in skeletal muscle injury or even after vigorous physical exercise. Disproportionate elevations of the AST and ALT levels when compared with the alkaline phosphatase level arise in diseases that primarily affect hepatocytes (ex; viral hepatitis). The AST/ALT ratio is not very useful in determining the cause of liver injury, except in acute alcoholic hepatitis, wherein, the ratio is usually > 2 and the AST level is 400 IU/mL or lower. Common causes of mild increases in AST and ALT levels is fatty liver disease seen most often in the context of obesity, diabetes, hyperlipidemia and alcohol abuse. The ratio of AST to ALT may give additional clues as to the cause:- In chronic liver disease with early cirrhosis ALT > AST,- In chronic liver disease with established cirrhosis AST > ALT. Extremes of the ratio of AST:ALT may also be sometimes useful:- ratio >2 suggests alcoholic hepatitis, and-Do not worry. It will take around 6 months for the enzymes to be normal again. Hope this answers your question. If you have additional questions or follow-up questions then please do not hesitate in writing to us. I will be happy to answer your questions. Wishing your daughters good health.