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Overview :
The serum amylase may be normal or only slightly increased in
patients with hyperlipemic pancreatitis, due to an apparent inhibiting substance
in the serum. This may cause a clinician to miss the diagnosis of pancreatitis
unless certain steps are taken.
Ways to diagnose pancreatitis in the setting of hyperlipemia
and a normal serum amylase value:
(1) Measure amylase activity in serial serum dilutions.
(2) Measure serum lipase levels, which may not be affected by
the lipemia.
(3) Determine the amylase to creatinine clearance ratio (see
Chapter 14).
Hyperlipidemia is associated with an inhibition of the serum
amylase assay. Serial dilution reduces this inhibition and will unmask elevated
amylase activity. A person without pancreatitis will show reduced activity
comparable to the degree of dilution.
An amylase to creatinine clearance > 5.5% favors the
diagnosis of acute pancreatitis, although the test may be affected by many
factors.
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