An interesting case of hyperamylasaemia? cause!
A normal lipase and an ACCR of <5% have effectively
excluded acute pancreatitis.
A significan decline of serum amylase level over 24h
and an ACCR of >1% have effectively excluded
macroamylasaemia.
What remained is parotitis (asymptomatic mumps). Up to
20% of mumps infections are asymptomatic and an
additional 40%-50% may have only nonspecific or
primarily respiratory symptoms as happend in this
case.
Amylase isoenzyme analysis is interesting to perform
on these samples to see if it shows predominant
S-isoamylase isoenzyme. An update on this case would
be appreciated.
regards
Mohammad
--- Steven Mccann <[log in to unmask]>
wrote: > Dear List members,
>
> Some help with the following case would be warmly
> received.
>
> A 32 year old and 32 week pregnant Asian lady
> presented at our A&E department with a short history
> of coughing and vomiting. Her only past medical
> history is that she is a type 2 diabetic, she did
> not have any abdo pain on presentation. Her recent
> glucose control has been good with levels between 4
> and 6 mmol/L, she has no ketones in her urine. The
> A&E Doctor in error requested an Amylase which came
> back as 2818U/L, (normal <100) her other U&E and
> LFT's were all normal. A lipase carried out on the
> same sample was normal 39 (<40)
> Further samples were received on the patient with
> the following amylase and lipase results
> Time Amylase Lipase
> 06/10/03 2am 2818 39
> 06/10/03 9am 1481 31
> 06/10/03 5.30pm 1620 37
> 07/10/03 00.30am 1928 41
> 07/10/03 11.17am 1161 41
>
> To exclude macroamylasaemia urine samples were sent.
>
> A urine sample was received at 12.30pm on the
> 06/10/03, the amylase and creatinine results were
> 3220 u/L and 6.6 mmol/L respectively. The nearest
> blood sample to this urine was 9am, where the
> amylase and creatinine were 1481 and 0.65mmol/L
> respectively. The calculated amylase clearance was
> 2.13%. Depending on your reference range this is
> normal, however levels tend to be high in
> pancreatitis.
>
> Another urine was received at 3pm on the 06/10/03
> the amylase and creatinine results were 1964 u/L and
> 4.5mmol/L respectively. The closest blood sample
> (5.30pm) to this urine had an amylase and creatinine
> of 1620 and 0.06mmol/L and gave a clearance of 1.8%,
> which is slightly low but not as low as the values I
> have previously seen in macroamylasaemia usually
> 0.05%.
>
> The patient was sent for a CT scan to try to image
> the pancreas, however due to pregnancy the gland
> could not be seen.
>
> The patient was then managed as if having
> pancreatitis, i.e 'drip and suck' (nil by mouth, on
> a dextrose saline drip and a nasogastric tube to
> drain gastric fluid). Due to the low clinical
> suspicion of pancreatitis and her pregnant state she
> was allowed to eat by mouth at noon on 07/10/03.
>
> Any thoughts on the causes of the raised amylase, we
> are currently using the Roche P units for general
> chemistry?
>
>
>
>
> Steven McCann
> Senior Clinical Scientist
> Department of Clinical Biochemistry
> Wythenshawe Hospital
> Southmoore Road
> Wythenshawe
> Manchester, M23 9LT
>
> Tel. no. 0161 291 4794
> Fax. no. 0161 291 2927
>
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=====
Dr. M A Al-Jubouri
Consultant Chemical Pathologist
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------ACB discussion List Information--------
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