Suppression of amylase activity by hypertriglyceridemia

Fallat, R.

doi:10.1001/jama.225.11.1331

Cited by 44 publications

(35 citation statements)

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“…The number of patients labeled as hypertriglyceridemia-associated pancreatitis was 18, of which only one patient (5.5%) had normal serum amylase and lipase level. Serial dilutions of the patient' s sample with the assay buffer to reduce interference of light transmission by hyperlipidemic serum can reveal an abnormal amylase value that was previously masked by the lactescent plasma [1] . O v e r a l l , a l t h o u g h p a n c r e a t i t i s c a u s e d b y hypertriglyceridemia has the same prognosis as other causes of the acute episode [6] , early recognition and treatment have been shown to hasten clinical recovery [7,8] .…”

Section: Discussionmentioning

confidence: 99%

“…Pancreatitis secondary to HTG, presents typically as an episode of acute pancreatitis (AP) or recurrent AP, rarely as chronic pancreatitis. Although AP often requires clinicians to rely on laboratory tests, such as serum amylase and lipase, as diagnostic aids, patients with acute pancreatitis secondary to HTG can have normal amylase [1] and lipase levels. Furthermore, acute pancreatitis is a recognized cause of chylous ascites [2] .…”

Section: Introductionmentioning

confidence: 99%

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Chylous ascites secondary to hyperlipidemic pancreatitis with normal serum amylase and lipase

Khan

Matar²

2007

WJG

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A 54-year old man with a family history of hyperlipidemia was admitted with a 12 h history of severe generalized abdominal pain associated with nausea, vomiting and abdominal distension. Examination of the abdomen revealed tenderness in the periumblical area with shifting dullness. Serum pancreatic amylase was 29 IU/L and lipase 44 IU/L, triglyceride 36.28 mmol/L. Ultrasound showed ascites. CT of the abdomen with contrast showed inflammatory changes surrounding the pancreas consistent with acute pancreatitis. Ultrasound (US) guided abdomen paracentesis yielded a milky fluid with high triglyceride content consistent with chylous ascites. The patient was kept fasting and intravenous fluid hydration was provided. Meperidine was administered for pain relief. On the following days the patient's condition improved and he was gradually restarted on a low-fat diet, and fat lowering agent (gemfibrozil) was begun, 600 mg twice a day. On d 14, abdomen US was repeated and showed fluid free peritoneal cavity. The patient was discharged after 18 d of hospitalization with 600 mg gemfibrozil twice a day. At the time of discharge, the fasting triglyceride was 4.2 mmol/L. After four weeks the patient was seen in the clinic, he was well.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Chylous ascites secondary to hyperlipidemic pancreatitis with normal serum amylase and lipase

Khan

Matar²

2007

WJG

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“…This was first thought to be due to interference of light transmission in the colorimetric reaction caused by lactescent serum specimens [10]. However, Warshaw et al [11] suggested the presence of circulating amylase inhibitors in the serum and urine in patients with hypertriglycerideinduced pancreatitis [11].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…However, Warshaw et al [11] suggested the presence of circulating amylase inhibitors in the serum and urine in patients with hypertriglycerideinduced pancreatitis [11]. True amylase levels can be determined after correcting the lactescent serum with serial dilutions with normal saline [10,11]. Interestingly, in one animal study, amylase levels were found to decrease by a factor of 4.33 in pancreases from hyperlipidemic acute necrotic pancreatitis compared with the normal-lipid acute necrotic pancreatitis group rats.…”

Section: Clinical Presentationmentioning

confidence: 99%

EmTriglyceride-Induced Pancreatitis: Diagnostic and Therapeutic Approach

Lu¹,

Agito²

2016

GHOA

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Hyper triglyceride-induced pancreatitis is rarely associated with triglyceride levels less than 1000 mg/dl. However, triglyceride levels can drop rapidly with fasting that often accompanies acute pancreatitis. In addition, triglyceride levels can be elevated in the setting of acute pancreatitis as injury to the pancreas causes inadequate lipid metabolism leading to triglyceride elevation. Thus, the question arises whether elevated triglycerides induce acute pancreatitis or vice versa in patients presenting with elevated triglyceride levels. Also, the drop in triglyceride levels associated with fasting may result in failure to consider hyper triglyceridemia as the etiology for acute pancreatitis in a patient who presents with triglyceride levels below 1000 mg/dL. In this review, we discuss the relationship between hyper triglyceridemia and pancreatitis as well as causes of elevated triglyceride levels that must be considered in patients who present with both conditions. In addition, we present an evidence based algorithm that summarizes the approach to hyper triglyceridemia and pancreatitis in the setting of complex medical co-morbidities.

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“…This is thought to be caused by an in-vitro interaction with high levels of lipid particles in lactescent serum. Serial dilutions of the serum can reduce this phenomenon and reveal abnormal levels of amylase [8]. Moreover, there are fewer available data interpreting the levels of lipase in HIAP [2,4].…”

Section: Figure 1 Computed Tomography Of Abdomen a At The Time Of Fmentioning

confidence: 99%

Hypertrygliceridemia-induced Acute Pancreatitis Following Hyperlipidemic Abdominal Crisis

Akay

Ardic

Erkan

2011

EAJM

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Hypertriglyceridemia is a well established cause of acute pancreatitis (AP). Multiple mechanism are proposed to explain this phenomenon, but the exact mechanism is unknown. Clinical manifestations are similar to other forms of AP. Although amylase and lipase levels exclude the diagnosis of AP in normolipidemic patients, they may be normal in hypertriglyceridemia-induced AP. Further evaluation with imaging studies are needed for diagnosis. A less known entity "hyperlipidemic abdominal crisis" is a prior clinical state before development to AP. We describe a young male patient without any previously diagnosed metabolic disorder presenting to emergency department with abdominal pain and vomiting where normal amylase in lactescent serum was detected. His abdomen computed tomography (CT) was reported as normal. His symptoms were relieved with antiemetic and histamine-2 blocker and he was diagnosed with hypertriglyceridemia and dyspepsia. Readmission with recurrence of symptoms after 3 hours resulted in hospitalization where the second CT showed edematous AP.

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Suppression of amylase activity by hypertriglyceridemia

Cited by 44 publications

References 0 publications

Chylous ascites secondary to hyperlipidemic pancreatitis with normal serum amylase and lipase

Chylous ascites secondary to hyperlipidemic pancreatitis with normal serum amylase and lipase

EmTriglyceride-Induced Pancreatitis: Diagnostic and Therapeutic Approach

Hypertrygliceridemia-induced Acute Pancreatitis Following Hyperlipidemic Abdominal Crisis

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