Letters

Acute pancreatitis

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7149.1982b (Published 27 June 1998) Cite this as: BMJ 1998;316:1982

Normal serum amylase does not exclude severe acute pancreatitis

  1. James K Torrens, Specialist registrar,
  2. P H M McWhinney, Senior registrar
  1. Department of Infectious Diseases, Seacroft Hospital, Leeds LS14 6UH
  2. Intensive Care Unit, Chelsea and Westminster Hospital, London SW10 9NH
  3. 24 Manor Park, Richmond, Surrey TW9 lXZ

    EDITOR—Mergener and Baillie highlight the problem of diagnosing acute pancreatitis if too much reliance is placed on the serum amylase level, drawing attention to the relatively low specificity of the test.1 They also state that amylase is rapidly cleared from the kidneys, and this, along with other factors, may lead to a normal serum amylase level even in the presence of necrotising pancreatitis.2

    We have recently seen two patients with severe necrotising pancreatitis and normal serum amylase levels (one of whom also had a normal result on abdominal ultrasonography), which led to a delay in establishing the correct diagnosis. Computed tomography showed pancreatic necrosis in both cases, and both patients required management in intensive care; one died subsequently from sepsis and multiorgan failure.

    Clinicians need to be aware not only of alternative causes of raised serum amylase but also of the fact that a normal serum amylase does not exclude severe forms of acute pancreatitis, which are associated with a high morbidity and mortality.

    References

    1. 1.
    2. 2.

    Major haemorrhage may be a late complication

    1. Ganesh Suntharalingam, Senior registrar,
    2. Richard Keays, Consultant,
    3. Neil Soni, Director
    1. Department of Infectious Diseases, Seacroft Hospital, Leeds LS14 6UH
    2. Intensive Care Unit, Chelsea and Westminster Hospital, London SW10 9NH
    3. 24 Manor Park, Richmond, Surrey TW9 lXZ

      EDITOR—In their clinical review of acute pancreatitis Mergener and Baillie point out that patients often get worse before they get better …

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