TY - JOUR
AU - Robitaille,, Daniel
AB - Case Description A 28-year-old woman presented to the emergency department for acute abdominal pain and was given 10 mg of intravenous morphine. An abdominal computed tomographic scan was performed but did not reveal any signs of pancreatitis or other causes for her symptoms. Blood for serum lipase testing was drawn 45 min after presentation and the results from 2 different instruments (Siemens Dimension EXL LM and Roche Cobas c501), with the second analysis performed following a phone call from the physician inquiring about the first result, are shown in Table 1. Table 1. Serum lipase activity measured by 2 instruments. Time . Siemens Dimension EXL LM (upper reference limit 400 U/L) . Roche Cobas c501 (upper reference limit 70 U/L) . 45 min after presentation (45 + AP) 1192 212 (45 + AP) + 10 h 320 30 (45 + AP) + 30 h 341 24 Time . Siemens Dimension EXL LM (upper reference limit 400 U/L) . Roche Cobas c501 (upper reference limit 70 U/L) . 45 min after presentation (45 + AP) 1192 212 (45 + AP) + 10 h 320 30 (45 + AP) + 30 h 341 24 Open in new tab Table 1. Serum lipase activity measured by 2 instruments. Time . Siemens Dimension EXL LM (upper reference limit 400 U/L) . Roche Cobas c501 (upper reference limit 70 U/L) . 45 min after presentation (45 + AP) 1192 212 (45 + AP) + 10 h 320 30 (45 + AP) + 30 h 341 24 Time . Siemens Dimension EXL LM (upper reference limit 400 U/L) . Roche Cobas c501 (upper reference limit 70 U/L) . 45 min after presentation (45 + AP) 1192 212 (45 + AP) + 10 h 320 30 (45 + AP) + 30 h 341 24 Open in new tab Questions What are the most common reasons for increased serum lipase? What is the most probable explanation for the increased lipase in this case? Would a serum amylase be helpful in this case? The answers are on the next page. Answers Serum lipase activity may be increased in acute pancreatitis, with obstruction of the pancreatic duct by a calculus or by a carcinoma of the pancreas, with renal insufficiency, and after administration of intravenous heparin (1, 2). In this case, given the magnitude and transient nature of the increased lipase, treatment with morphine is the likely cause. Morphine is known to cause contractions in the sphincter of Oddi and may cause transient increases in lipase and amylase in healthy individuals (3). In this patient, serum amylase activity was increased for the same reason as lipase activity and no identifiable cause was found to explain her abdominal pain. " Author Contributions:All authors confirmed they have contributed to the intellectual content of this paper and have met the following 3 requirements: (a) significant contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting or revising the article for intellectual content; and (c) final approval of the published article. " Authors' Disclosures or Potential Conflicts of Interest:No authors declared any potential conflicts of interest. References 1. Burtis CA , Ashwood ER, Bruns DE , editors. Tietz textbook of clinical chemistry and molecular diagnostics . 5th edition. Philadelphia : Saunders Elsevier ; 2012 . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 2. Wu AHB . Tietz Clinical Guide to Laboratory Tests . 4th edition. St. Louis (MO) : Saunders Elsevier ; 2006 . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 3. Lobo DN , Takhar AS, Thaper A, Rowlands BJ . The morphine-prostigmine provocation (Nardi) test for sphincter of Oddi dysfunction: results in healthy volunteers and in patients before and after transduodenal sphincteroplasty and transampullary septectomy . Gut 2007 ; 56 : 1472 – 3 . Google Scholar Crossref Search ADS PubMed WorldCat © 2017 The American Association for Clinical Chemistry This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - Large Increase in Serum Lipase in the Absence of Pancreatitis
JF - Clinical Chemistry
DO - 10.1373/clinchem.2016.267427
DA - 2017-03-01
UR - https://www.deepdyve.com/lp/oxford-university-press/large-increase-in-serum-lipase-in-the-absence-of-pancreatitis-BlTPMlenp5
SP - 789
VL - 63
IS - 3
DP - DeepDyve
ER -