BMJ  2005;331:890-891 (15 October), doi:10.1136/bmj.331.7521.890

Clinical review

Lesson of the week

Hyperamylasaemia: not the usual suspects

Rajeev Srivastava, specialist registrar1, Callum Fraser, consultant biochemist1, Douglas Gentleman, consultant2, Lynne A Jamieson, specialist registrar3, Michael J Murphy, senior lecturer1

1 Department of Biochemical Medicine, Ninewells Hospital, Dundee, 2 Centre for Brain Injury Rehabilitation, Royal Victoria Hospital, Dundee, 3 Department of Histopathology, Ninewells Hospital, Dundee

Correspondence to: R Srivastava rajeev.srivastava@tuht.scot.nhs.uk

The first 150 words of the full text of this article appear below.

Introduction

Interpretation of abnormally high serum amylase activity is not always straightforward. Sometimes, as here, patients are erroneously labelled as having pancreatitis despite the absence of clinical features to support this diagnosis. Such assumptions may affect the interpretation of investigations.

Case report

A 53 year old woman was admitted to hospital, initially with a dense hemiparesis and dysarthria because of a left middle cerebral infarct. At the time of admission, she was recovering from a recent myocardial infarction. She was not known to be diabetic.

About six weeks after admission she complained of several episodes of vomiting. Routine haematology and biochemistry investigations were unremarkable apart from serum amylase activity of 1730 U/l (reference interval 0-100 U/l). This result immediately prompted surgical review. The surgical senior house officer diagnosed acute pancreatitis. A few days later the surgical registrar confirmed this clinical impression, although, in the complete absence of abdominal pain, the pancreatitis was described . . . [Full text of this article]

Discussion


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