What is the significance of elevated amylase (Amylase) at 138 units per liter (u/l)?

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Last updated: May 23, 2025 • View editorial policy

From the Guidelines

An amylase level of 138 U/L is not indicative of acute pancreatitis, as it is less than three times the upper limit of normal, and therefore, no specific treatment or intervention is needed for this result. According to the 2019 WSES guidelines for the management of severe acute pancreatitis 1, the cut-off value of serum amylase and lipase is normally defined to be three times the upper limit. Since the provided amylase level does not exceed this threshold, it is not considered diagnostic of acute pancreatitis. Amylase is an enzyme primarily produced by the pancreas and salivary glands that helps digest carbohydrates. Elevated amylase levels often indicate pancreatic inflammation or damage, but a level of 138 U/L may not be clinically significant.

If symptoms like abdominal pain, nausea, or vomiting are present, it is recommended to consult a healthcare provider for further evaluation, as context matters when interpreting laboratory values. Factors such as kidney function, medications, and other medical conditions can influence amylase levels. Regular follow-up with a healthcare provider is recommended to monitor any changes if there are ongoing concerns, but this isolated value alone typically wouldn't warrant specific treatment or urgent intervention. The diagnosis of acute pancreatitis should be established within 48 hours of admission, based on compatible clinical features and elevations in amylase or lipase levels, as stated in the AGA Institute medical position statement on acute pancreatitis 2.

In the absence of gallstones or significant history of alcohol use, serum triglyceride and calcium levels should be measured, as recommended by the 2019 WSES guidelines 1. Serum triglyceride levels over 11.3 mmol/l (1000 mg/dl) indicate it as the etiology. Other laboratory findings, such as C-reactive protein, hematocrit, and procalcitonin, can be used to characterize an episode of severe acute pancreatitis and predict the development of necrosis or infected necrosis 3. However, these findings are not directly relevant to the interpretation of the provided amylase level.

Key points to consider:

  • Amylase level of 138 U/L is not diagnostic of acute pancreatitis
  • No specific treatment or intervention is needed for this result
  • Consult a healthcare provider if symptoms are present
  • Regular follow-up is recommended to monitor any changes
  • Other laboratory findings can be used to characterize an episode of severe acute pancreatitis, but are not directly relevant to the interpretation of the provided amylase level.

From the Research

Serum Amylase Levels

  • The given serum amylase level is 138 u/l.
  • According to the study 4, the reference value for serum amylase is between 10-220 U/L.
  • The provided amylase level of 138 u/l is within the normal range, but close to the upper limit.

Diagnostic Yield of Elevated Amylase

  • A study 5 found that mild elevations of amylase and/or lipase rarely predict significant pancreatic pathology.
  • In this study, 78.9% of patients with mild elevations of amylase and/or lipase had no identifiable pancreatic pathology.
  • The diagnostic yield in patients with mild elevations of lipase alone was particularly poor.

Comparison of Amylase and Lipase

  • A study 6 compared the utility of serum amylase and lipase in the diagnosis of acute pancreatitis.
  • The study found that all 50 patients with acute pancreatitis had raised serum lipase, while 42 patients had both amylase and lipase raised.
  • Another study 7 found that lipase was elevated 5 times higher above its respective upper reference limit than amylase at admission.

Clinical Significance of Amylase Levels

  • A study 8 found that elevations of amylase and lipase levels did not predict future risk of acute pancreatitis in patients treated with liraglutide.
  • The study also found that liraglutide-treated patients had increases in serum lipase and amylase, but these increases were not predictive of an event of subsequent acute pancreatitis.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.