Would it be worth assaying serum lipase on the next few days' specimens
to exclude a later rise? And I imagine you'll be assaying the amylase
anyway...
Would it be worth looking at the amylase isoenzymes? Detecting raised
salivary type without raised pancreatic type would confirm that this
wasn't pancreatitis. AssayFinder has one provider...
With low clinical suspicion and an unremarkable plasma lipase I would
conclude this wasn't acute pancreatitis. (Level of evidence on the
usual 1 to 5 scale: about 7).
Jonathan
On Tuesday, Oct 7, 2003, at 18:25 Europe/London, Steven Mccann 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
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