From the Guidelines
Low lactate dehydrogenase (LDH) levels in an adolescent with abdominal pain are not a reliable indicator of a specific diagnosis and should not be used to rule out serious conditions. The evaluation of abdominal pain in adolescents should focus on a comprehensive assessment, including a detailed history, physical examination, and appropriate diagnostic tests based on the clinical presentation, as suggested by the American College of Radiology in their 2019 guidelines for suspected appendicitis in children 1. Some key points to consider in the evaluation of abdominal pain in adolescents include:
- A comprehensive assessment is crucial, as the differential diagnosis for acute abdominal pain in children is broad and includes infectious, inflammatory, musculoskeletal, traumatic, gynecologic, and other etiologies 1.
- Common causes of abdominal pain in adolescents include appendicitis, inflammatory bowel disease, ovarian pathology in females, testicular torsion in males, urinary tract infections, constipation, and functional gastrointestinal disorders.
- Diagnostic tests such as complete blood count, comprehensive metabolic panel, urinalysis, and imaging studies like ultrasound or CT scan should be guided by the pattern of pain, associated symptoms, and physical exam findings.
- The American College of Radiology emphasizes the importance of imaging in the diagnosis of pediatric acute appendicitis, highlighting its role in facilitating management and decreasing the rate of negative appendectomies in children with suspected acute appendicitis 1. It is essential to note that while LDH can be elevated in conditions involving tissue damage or cell turnover, a low value does not provide specific diagnostic information, and the clinician should not be reassured by a low LDH value alone 1. Therefore, a low LDH level should not influence the decision to pursue further diagnostic evaluation based on the clinical presentation.
From the Research
Significance of Low Lactate Dehydrogenase (LDH) in Adolescent with Abdominal Pain
- Low LDH levels are not specifically addressed in the provided studies as a significant factor in the diagnosis of abdominal pain in adolescents.
- However, elevated LDH levels are mentioned in the study 2 as a clinically significant finding in patients with partial renal infarction, suggesting that LDH may be useful in diagnosing certain conditions that cause abdominal pain.
- The study 2 found that all patients with partial renal infarction had elevated LDH levels, and that this finding, combined with other clinical signs and symptoms, should alert clinicians to the possibility of renal infarction.
- In contrast, the other studies provided do not mention LDH as a significant factor in the diagnosis of abdominal pain, and instead focus on other laboratory tests, such as complete blood count, blood chemistries, and urinalysis, as well as imaging modalities like ultrasonography and computed tomography.
- It is worth noting that the study 3 mentions lactate levels as part of the initial laboratory evaluation for acute abdominal pain in children, but does not specifically address LDH levels.
Laboratory Tests and Imaging Modalities
- The studies provided suggest that a variety of laboratory tests and imaging modalities may be useful in diagnosing the cause of abdominal pain in adolescents, including:
- However, the specific tests and imaging modalities used will depend on the clinical presentation and suspected diagnosis, and should be guided by evidence-based guidelines and clinical judgment.