Significantly elevated serum lipase in pregnancy with nausea and vomiting: acute pancreatitis or hyperemesis gravidarum?

Amanda Johnson,Bethany Cluskey,Nina Hooshvar,Daphne Tice,Lihua Zhang,Courtney Devin,Steven Jones,Suhalia Nawabi,Chi Dola,Elaine Kao

doi:10.1155/2015/359239

Amanda Johnson, Bethany Cluskey + Show 8 more

Open Access

https://doi.org/10.1155/2015/359239

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Abstract

Hyperemesis gravidarum is a severe manifestation of nausea and vomiting of pregnancy and it is associated with weight loss and metabolic abnormalities. It is known that abnormal laboratory values, including mildly elevated serum lipase level, could be associated with hyperemesis gravidarum. However, in this case report details of two women with hyperemesis gravidarum but with significantly elevated serum lipase levels were discussed. These patients presented with severe nausea and vomiting but without abdominal pain. They were found to have severely elevated lipase levels over 1,000 units/liter. In the absence of other findings of pancreatitis, they were treated with conservative measures for hyperemesis gravidarum, with eventual resolution to normal lipase levels. Although significantly elevated lipase level in pregnant patients with nausea and vomiting is a concern for acute pancreatitis, these two cases of significantly elevated serum lipase without other clinical findings of pancreatitis led to this report that serum lipase could be quite elevated in hyperemesis gravidarum and that it might not be an accurate biochemical marker for acute pancreatitis. Imaging studies are thus necessary to establish the diagnosis of acute pancreatitis.

Highlights

Nausea and vomiting of pregnancy is the most common medical condition affecting pregnancy and is present in up to 85% of gestations [1, 2]
We present two cases of hyperemesis gravidarum but with significantly elevated serum lipase levels and without signs of pancreatitis
Diagnostic criteria for pancreatitis in pregnancy include the presence of typical abdominal pain, elevated serum amylase or lipase to levels greater than three times normal serum values, and confirmatory findings of pancreatitis on abdominal imaging [8, 11]

Summary

Introduction

Nausea and vomiting of pregnancy is the most common medical condition affecting pregnancy and is present in up to 85% of gestations [1, 2]. Severity ranges from mild symptoms of nausea and vomiting to severe incapacitation, or hyperemesis gravidarum. Risk factors include increased placental mass, as seen with multiple gestations or trophoblastic disease, a personal or family history of hyperemesis gravidarum, a history of motion sickness or migraines, and carrying a female fetus [1, 4]. Hyperemesis gravidarum is a diagnosis of exclusion, with other potential causes of nausea and vomiting in pregnancy including multiple gestation, hydatidiform mole, preeclampsia, gastroenteritis, dyspepsia, gastroparesis, gastroesophageal reflux disease, cholecystitis, pancreatitis, migraines, malignancy of the central nervous system, pseudotumor cerebri, hyperthyroidism, uremia, Addison’s disease, diabetic ketoacidosis, pyelonephritis, and drug toxicity [1]. We present two cases of hyperemesis gravidarum but with significantly elevated serum lipase levels and without signs of pancreatitis

Case Report

Findings

Discussion