Persistently raised alkaline phosphatase in a woman with osteomalacia

doi:10.1136/bmj.b1874

Published 3 June 2009, doi:10.1136/bmj.b1874
Cite this as: BMJ 2009;338:b1874

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Case report

Persistently raised alkaline phosphatase in a woman with osteomalacia

H U Rehman, clinical assistant professor

¹ Department of General Internal Medicine, Regina Qu’Appelle Health Region, Regina, Canada SK S4P 0W5

habib31@sasktel.net

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

A 45 year old woman was referred by psychiatrists for assessmentof raised alkaline phosphatase. She had been admitted to a psychiatryward for management of schizophrenia and was being treated withfluphenazine and olanzapine. She had been otherwise well anddenied any gastrointestinal symptoms or any bone or muscle pains.Her blood tests results were as follows (normal ranges in brackets)):

Sodium 141 mmol/l (135-145)

Potassium 3.9 mmol/l (3.5-5.0)

Chloride 105 mmol/l (98-110)

Anion gap 13 mmol/l (10-20)

Urea 7.8 mmol/l (3.0-7.1)

Creatinine 121 µmol/l (60-130)

Calcium 2.42 mmol/l (2.14-2.66)

Alkaline phosphatase 239U/l (40-135)

Alanine transaminases 45 U/l (4-55)

Bilirubin7 µmol/l (2-20)

Abdominal ultrasound showed normal physiology in the gallbladder,common bile duct, common hepatic duct, and liver parenchyma.Further tests showed that the patient was vitamin D deficient,with a serum level of calcidiol of 23 nmol/l (normal range 25-250nmol/l). Tests for anti-nuclear and anti-mitochondrial . . . [Full text of this article]

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