Acute pancreatitis with normal amylase and lipase—an ED dilemma

Singh, Abhijai; Shrestha, Mahesh; Anand, Curuchi

doi:10.1016/j.ajem.2015.10.026

Cited by 13 publications

(15 citation statements)

References 6 publications

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“…HTGP should be suspected with severe HTG and clinical picture consistent with acute pancreatitis, which is established when two of the following three findings are present: epigastric abdominal pain; elevated serum enzyme, three or more times the upper limit of normal; or radiologic imaging consistent with acute pancreatitis ( 4 ). Our patient had various spurious laboratory abnormalities including normal amylase levels, pseudohyponatremia, and falsely low TG levels compared with the repeat testing on the same initial sample which was consistent with few previously reported cases ( 5 , 6 ). Normal amylase levels can be present in patients with TG levels above 500 mg/dl due to interference with the calorimetric reading.…”

Section: Discussionsupporting

confidence: 91%

“…The solution for samples with surprisingly low results is to re-assay after diluting or using a smaller volume of sample ( 6 ). Although our patient had high lipase levels, there is literature on cases of HTGP patients with normal lipase levels( 5 ), the reason being unknown ( 4 ). To the best of our knowledge, this is the second case in literature where falsely low TG levels were present on admission requiring repeated laboratory testing on the same initial sample for accurate results.…”

Section: Discussionmentioning

confidence: 69%

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Hypertriglyceridemic pancreatitis associated with confounding laboratory abnormalities

Melnick

Nazir

Gish

et al. 2016

Journal of Community Hospital Internal Medicine Perspectives

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We present the case of a 36-year-old woman who presented to our hospital with epigastric abdominal pain and tenderness. Laboratory evaluation identified high lipase, normal amylase, pseudohyponatremia, and relatively falsely low triglyceride levels (initial value of 2,329 mg/dl which on repeat was found to have corrected value of >10,000 mg/dl). The overall clinical picture was consistent with acute pancreatitis due to hypertriglyceridemia. The patient was commenced on IV insulin and eventually required plasmapheresis with good clinical outcome. This case highlights the importance of being cognizant of falsely low amylase and TG levels that can be present in patients with hypertriglycereidemic pancreatitis

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 69%

Hypertriglyceridemic pancreatitis associated with confounding laboratory abnormalities

Melnick

Nazir

Gish

et al. 2016

Journal of Community Hospital Internal Medicine Perspectives

View full text Add to dashboard Cite

show abstract

“…One study designed by Randall et al showed lipemia interferences with determination of glucose, phosphorus, total bilirubin, uric acid, and total protein by the Beckman Synchron CX5 [22]. Falsely low levels of amylase and rarely lipase are also seen in lipemic samples [23,24]. According to Agarwal study, glucose and albumin are not affected by lipemia [25].…”

Section: Discussionmentioning

confidence: 99%

Lipemia Interferences in Biochemical Tests, Investigating the Efficacy of Different Removal Methods in comparison with Ultracentrifugation as the Gold Standard

Soleimani

Mohammadzadeh

Asadian

2020

Journal of Analytical Methods in Chemistry

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Introduction. As a common interferer in clinical chemistry, lipemic specimens could be a source of significant analytical errors. Ultracentrifugation has been by far the only reliable, but an unavailable and expensive, method to eliminate the lipemic effect. Materials and Methods. Among the daily samples, those with triglyceride >400 mg/dL (4.6 mmol/L) and also turbid were selected, divided into three groups, based on triglyceride concentration, and three pooled serums were made for each group. Then all pooled serums were investigated by using a DIRUI biochemistry analyzer CS-800 for routine chemistry tests in different methods including direct measurement, serum blank, serum dilution, and measurement after ultracentrifugation. Results. According to our study, there were significant differences before and after ultracentrifugation in all lipemic levels and for all parameters except for alanine aminotransferase (ALT), alkaline phosphatase (ALP), bilirubin, and uric acid. Based on allowable inaccuracy for each parameter, calcium, magnesium, phosphorus, total protein, iron, total iron-binding capacity (TIBC), urea, and chloride are being influenced by all lipemic degree and neither serum dilution nor using serum blank is as effective as ultracentrifuge for elimination. Serum blank was a proper method of lipid removal for the measurement of glucose. Conclusion. Lipemia is a well-known interferer in clinical chemistry. One cannot avoid lipemia, but fortunately, severe lipemia is a rare phenomenon in the laboratory, and for assessment of some analytes in a lower degree of lipemia, use of serum blank eliminates the need for ultracentrifuge.

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“…Our data confirmed a significant reduction of amylase and lipase levels with the elevation of TG. Furthermore, case reports have been published by Singh et al [26] and Sotello et al [27], presenting HTG-AP patients with normal amylase and lipase levels.…”

Section: Discussionmentioning

confidence: 99%

Hypertriglyceridemia-induced acute pancreatitis: A prospective, multicenter, international cohort analysis of 716 acute pancreatitis cases.

et al. 2020

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Acute pancreatitis with normal amylase and lipase—an ED dilemma

Cited by 13 publications

References 6 publications

Hypertriglyceridemic pancreatitis associated with confounding laboratory abnormalities

Hypertriglyceridemic pancreatitis associated with confounding laboratory abnormalities

Lipemia Interferences in Biochemical Tests, Investigating the Efficacy of Different Removal Methods in comparison with Ultracentrifugation as the Gold Standard

Hypertriglyceridemia-induced acute pancreatitis: A prospective, multicenter, international cohort analysis of 716 acute pancreatitis cases.

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