From the Guidelines
Elevated lipase levels in the blood typically indicate inflammation or damage to the pancreas, most commonly due to acute pancreatitis, and thus, if you have elevated lipase, seek medical attention promptly, especially if experiencing abdominal pain, nausea, or vomiting. 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 more specific and preferred 1. Treatment depends on the underlying cause but often includes fasting to rest the pancreas, intravenous fluids for hydration, and pain management with medications like acetaminophen or, in severe cases, opioids. For mild elevations without symptoms, your doctor may recommend monitoring levels over time. Avoid alcohol and fatty foods which can worsen pancreatic inflammation. The elevation occurs because damaged pancreatic cells release more lipase into the bloodstream than normal. While pancreatitis is the most common cause, elevated lipase can also result from kidney disease, intestinal obstruction, peptic ulcer disease, or certain medications. The degree of elevation doesn't always correlate with severity of disease, so clinical assessment alongside laboratory values is essential for proper diagnosis and treatment. Some key points to consider in the management of elevated lipase include:
- Repeated and combined measurement of serum amylase and lipase levels, starting from 3 to 6 h after the initial injury, is a useful tool to support clinical evaluation in suspicion of pancreatic injury 1.
- CT-scan with intravenous contrast is essential in diagnosing duodeno-pancreatic injuries in hemodynamically stable or stabilized trauma patients 1.
- Administration of oral contrast material does not improve intravenous contrast-enhanced CT-scan sensitivity in detecting duodeno-pancreatic injuries 1.
- A repeat CT-scan within 12–24 h from the initial injury should be considered in hemodynamically stable patients with high clinical suspicion for duodeno-pancreatic injury or pancreatic ductal injury with negative CT-scan or non-specific CT findings on admission imaging, and/or elevated amylase and lipase, or persistent abdominal pain 1. According to the 2019 WSES guidelines for the management of severe acute pancreatitis, serum lipase is considered a more reliable diagnostic marker of AP than serum amylase, with higher sensitivity and larger diagnostic window 1.
From the Research
Elevated Lipase
Elevated lipase levels can be an indicator of acute pancreatitis, as well as other pancreatic and non-pancreatic conditions.
- The sensitivity and specificity of serum lipase for diagnosing acute pancreatitis have been found to be higher than those of amylase in some studies 2, 3.
- Serum lipase levels can be elevated in many intra-abdominal inflammatory conditions, and are not sufficient to diagnose acute pancreatitis in patients with abdominal pain on their own 4.
- The use of lipase as a diagnostic biomarker for acute pancreatitis has been recommended by several evidence-based guidelines, due to its higher sensitivity and larger diagnostic window compared to amylase 3.
Diagnosis of Acute Pancreatitis
The diagnosis of acute pancreatitis is typically based on the presence of abdominal pain and elevated levels of serum amylase and/or lipase.
- However, attempts have been made to validate newer biomarkers, including pancreatic elastase, serum trypsin, and urinary trypsinogen-activated peptide, for the diagnosis of acute pancreatitis 4.
- Radiological evidence and increased cut-off levels of enzyme elevation may be necessary for a more accurate diagnosis of acute pancreatitis 4.
- The co-ordering of both lipase and amylase tests has shown little to no increase in diagnostic sensitivity and specificity, and may result in unnecessary testing and laboratory expenditures 3.
Treatment of Acute Pancreatitis
Fluid resuscitation is an important aspect of the treatment of acute pancreatitis.
- Lactate Ringer's solution (LR) has been compared to Normal Saline (NS) in the treatment of acute pancreatitis, with some studies suggesting that LR may be more effective in reducing the incidence of systemic inflammatory response syndrome (SIRS) and local complications 5.
- However, other studies have found no significant difference in clinical outcomes between the use of LR and NS in the treatment of acute pancreatitis 6.