https://www.ncbi.nlm.nih.gov/pmc/articles/PMC545762/pdf/20050201s00028p367.pdf

Dear Vardan,

Thank you for participation and the link provided.

Best regards

Aly

Dear Aly, I would repeat the test and ask for alcohol consumption.

Dear Daniel 

This is repeatedly happened

Though ALT is produced in liver, AST is produced in other organs like heart, muscle etc apart from liver so one has to look for any diseases of these organs also. But a full LFT is important to consider liver causes, the commonest of which is alcoholic hepatitis and advanced liver cirrhosis, all of which are associated with other LFT abnormalities.

Try to dilute the serum before measuring ALT it may be very high to limit that need dilution 

if no change in results .. so the pathology is more accurate if you work on experimental model .. i had the same results but with experimental model and depended on pathology 

Confirm a possible liver damage with GGT as well. Repeat AST after 1-2 months if GGT is normal. In that case the  liver is OK so it would be better to focus the attention on other organs. 

Elevated AST (269 U/L) alone with normal ALT.

Both aminotransferases (ALT and AST) are found in the liver. However, AST is also diffusely represented in the heart, skeletal muscle, kidneys, brain and red cells.

Full LFT is required ion this case.

Suggest to refer "Liver enzyme alteration: a guide for clinicians" by Edoardo G. Giannini et al. CMAJ. 2005 Feb 1; 172(3): 367–379.

This is a very common finding in heavy drinkers and also in some cases os settee-hepatitis

if liver diseaes are discarded, another rare diagnosis is that of macroasparate aminotransferase. see Macroaspartate Aminotransferase (Macro-AST) A Rare Cause of Hipertransaminasemia: Another Way to Diagnosis?

Castiella, Agustin MD*; Aguayo, Francisco J. MD†; Rueda, Miguel MD‡; Fernandez, Javier MD*; Zapata, Eva MD*

Journal of Clinical Gastroenterology: August 2006 - Volume 40 - Issue 7 - p 655

Letters to the Editor

kind regards.

Dear Dr Agustin,

Thank you for your new dimension to answer my question.

Best regards

Aly

@Gautam Ray Yes AST produce from other organs , LFT is done and repeated, the results are the same, the patient is not alcoholic.

Best regards

Aly 

Please look for disorders of muscle (heart, skeletal) by estimating CPK, aldolase and those of RBC by parameters of hemolysis like LDH, bilirubin (direct/indirect), hemoglobin and of course kidney function tests. Regards