From the Guidelines
To address elevated lipase levels, first identify and treat the underlying cause, which is most commonly pancreatitis, and consider the most recent guidelines from 2019 1. When evaluating elevated lipase levels, it's crucial to understand that lipase is more specific than amylase for diagnosing acute pancreatitis, with a higher sensitivity and larger diagnostic window 1. 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, with lipase being preferred due to its higher specificity 1. Key considerations in managing elevated lipase include:
- Identifying and treating the underlying cause, which could be acute or chronic pancreatitis
- For acute pancreatitis, treatment typically involves fasting to rest the pancreas, intravenous fluids, and pain management with medications like morphine or hydromorphone
- Gradually reintroducing a low-fat diet once symptoms improve
- For chronic causes, lifestyle modifications are essential, including avoiding alcohol, stopping smoking, maintaining a low-fat diet, and staying well-hydrated
- Regular monitoring of lipase levels to track improvement
- Considering hospitalization for intensive treatment if pancreatitis is severe It's also important to note that certain medications may need adjustment or discontinuation if they're contributing to elevated lipase, including thiazide diuretics, opioids, or certain antibiotics 1. In cases of hypertriglyceridemia-associated pancreatitis, treatment of the hypertriglyceridemia is crucial to improve outcomes and prevent further pancreatic damage, and plasma exchange or lipoprotein apheresis may be considered in severe cases 1. Overall, addressing the source of inflammation is crucial for normalizing lipase levels and preventing complications like pancreatic necrosis or systemic inflammatory response syndrome.
From the Research
Understanding Elevated Lipase Levels
Elevated lipase levels can be an indication of various conditions, not just pancreatitis. It is essential to consider other potential causes of elevated lipase and not assume that all cases are associated with pancreatitis 2.
Possible Causes of Elevated Lipase
Some possible causes of elevated lipase levels include:
- Inflammatory bowel disease
- Infectious colitis
- Nonpancreatic abdominal pain
- Drug-induced acute pancreatitis, such as hydrochlorothiazide use 3
- Other intra-abdominal inflammatory conditions
Diagnosis and Testing
Serum lipase levels can be elevated in many conditions, and it is not sufficient to diagnose acute pancreatitis in patients with abdominal pain alone 4.
- Serum lipase levels are more sensitive and specific than amylase for diagnosing acute pancreatitis 5, 6
- A serum lipase level > 3 normal has a better diagnostic accuracy than serum amylase in differentiating nonpancreatic abdominal pain from acute pancreatitis 5
- Radiological evidence and increased cut-off levels of enzyme elevation can help in making a more accurate diagnosis of acute pancreatitis 4
Clinical Implications
Emergency physicians should be aware of other potential causes of elevated lipase and not assume that all cases are associated with pancreatitis 2.
- Discontinuation of certain medications, such as hydrochlorothiazide, may result in symptom resolution and no recurrence of acute pancreatitis 3
- Testing lipase alone can reduce unnecessary testing and laboratory expenditures, as co-ordering both lipase and amylase has shown little to no increase in diagnostic sensitivity and specificity 6