ISOLATED HYPERLIPASEMIA ASSOCIATED WITH HYPEREMESIS GRAVIDARUM AND PARENTERAL NUTRITION

Abstract

Isolated elevation of serum lipase with normal amylase is a rare biochemical finding that has been described in patients with malignant tumors, renal insufficiency, hypertriglyceridemia and macrolipasemia. We present two cases of hyperlipasemia associated with hyperemesis gravidarum (HG). The patients were two African American women on their first pregnancies, without significant medical history, hospitalized for severe HG. Physical exam was unremarkable and laboratory values showed increased serum lipase levels more than three times the upper normal limit with normal serum amylase, and acute pancreatitis was suspected. The elevation persisted for more than a week after the resolution of the symptoms. Parenteral nutrition (PN) appears to be associated with further increase in serum lipase values. The first patient, a 32-year-old woman 16 weeks pregnant G1PO was started on PN at home because of persistent nausea, vomiting, and low caloric intake. The serum lipase of 1082 U/L on admission, increased to a peak level of 3506 U/L during hospitalization with the patient on PN. After discontinuing PN and starting a liquid diet, lipase had a descending trend. The lipase values have normalized after discharge. The second patient, a 19-year-old woman 9 weeks pregnant G1PO presented with a serum lipase of 698 U/L, which increased to speak level of 1491 U/L. Short term PN led to an increase in serum lipase. Subsequently the lipase level decreased with the patient on liquid diet and was reported normal on the follow-up visit. The possibility of isolated hyperlipasemia in patients with HG should be considered to avoid unnecessary diagnostic and therapeutic procedures. It is not clear if the origin of lipase is pancreatic, perhaps due to microlithiasis or nonpancreatic from intestinal, gastric or lingual sources. The transient nature of hyperlipasemia and the normal serum amylase level make the diagnosis of macrolipasemia less likely. Also avoidance or early discontinuation of PN can lead to a normalization of serum lipase level.[figure 1]Figure