Regarding urinary amylase, I would aggree with the previous correspondents
that the main use of a urine amylase is the identification of
macroamylasaemia but would like to add a cautionary note.
2 patients in ICU recently had elevated amylase (but normal lipase). The
urine amylase was normal and there was no evidence of pancreatitis -
sounding good for macroamylasaemia! However the amylase returned to normal
over a few days. Further investiagtion showed this patient was a few days
after coronary artery bypass grafting where a hypermaylasaemia has been
described. The amylase is pancraetic in origin but there is no evidence of
pancreatitis. The mechanism seems to be a altered renal handling of
pancreatic amylase leading to a transient rise in the serum level. Note
that this can occur without change in serum creatinine. (Paajanen H et al.
Scand Cardiovasc J. 1997;31:137-40).
With the second patient we watched expectently and saved on pancreatic
imaging. Lipase wins again!
Graham Jones
Staff Specialist in Chemical Pathology
St Vincent's Hospital Sydney
At 08:28 AM 11/25/98 +0000, you wrote:
>For the first time for many years I have been requested to carry out
>a urinary amylase on a child with an RTA. Reading the literature
>gives me the strong impression that this test is redundant although
>it was frequently requested in my youth - a long time ago for those of
>you who do not know me. Have I got the right idea or is my view
>coloured by the paediatric nature of my practice? Do many labs
>continue to offer this test and if so for what clinical situations?
>
>Mike Addison
>Dr G.Michael Addison
>Royal Manchester Children's Hospital
>Pendlebury
>Manchester M27 4HA
>United Kingdom
>
>Tel 0161-727-2250(AM)or 0161-220-5342(PM)
>FAX 0161-727-2249
>Email [log in to unmask]
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