GPT and acute liver failure: However, on the third day, he developed acute liver failure (ALF) with an aspartate aminotransferase (AST) of 25 000 IU/L (reference 8-46 IU/L), an alanine aminotransferase (ALT) of 6500 IU/L (reference 7-55 IU/L), a γ-glutamyl transferase of 210 IU/L (reference 0-65 IU/L), an alkaline phosphatase (ALP) of 130 IU/L (reference 45-115 IU/L), a total bilirubin of 2.3 mg/dL (reference 0.1-1.2 mg/dL), and a direct bilirubin 0.4 mg/dL (reference <0.3 mg/dL).