Amylase and lipase are both elevated in acute pancreatitis. In which clinical situation does serum lipase have a decisive advantage over amylase for diagnosis?
- A Pancreatitis presenting 4–5 days after onset of symptoms when amylase has normalised ✓
- B Alcoholic pancreatitis presenting within 2 hours of alcohol ingestion
- C Pancreatitis in a patient with normal renal function on day 1
- D Pancreatitis complicated by hypocalcemia
Correct answer: A. Pancreatitis presenting 4–5 days after onset of symptoms when amylase has normalised
Explanation
Serum amylase rises quickly but returns to normal within 3–5 days, while serum lipase remains elevated for 7–14 days because it has a longer serum half-life and no salivary isoform to confound results. In patients who present late (day 4–5), amylase may have normalized while lipase remains diagnostically elevated. Both enzymes rise similarly on day 1 in patients with normal renal function, so lipase has no advantage there.
Reference: Harper's Illustrated Biochemistry, 32nd ed.
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