Peter,
My money would be on benign transient hyperphosphataseamia, detected purely
coincidentally at the time of the overdose. I assume his calcium and
phosphate were norrmal?? The magnitude of the increase, and the rapid change
over a week or so would be in agreement with this surprisingly common
biochemical 'abnormality'.
Our usual advice is to repeat the ALP after approximately 2 weeks to check
it is falling as expected - you have already done this. Sometimes it isn't,
because the first sample was taken when it was on the way up. If there is
clinical concern eg if the finding is in a child with significant other
pathology - we have seen it in numerous oncology patients - we will carry
out ALP isoenzymes by electrophoresis for confirmation and reassurance. If
you have any leftover plasma we'd be happy to do this for your case.
Regards
Dr Jean M Kirk
Consultant Biochemist
Royal Hospital for Sick Children
Edinburgh
-----Original Message-----
From: [log in to unmask]
[mailto:[log in to unmask]]On Behalf Of Peter
Stromberg
Sent: 16 October 2000 14:41
To: [log in to unmask]
Subject: OVERDOSE
A little bit of advice from listeners please.
A 2 year old child takes his brothers nefedipine and tachrolimus ( renal
transplant ) and presents with the following biochemistry
DATE ALK PHOS BILI ALT GGT
2/10 7565 3 20 4
10/10 2730 2.1 15 3
Normal alk phos for growing child < 1000
All other LFTs normal
The child is normal clinically.The clinician wants to know the expected
outcome and should anything else be done.
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