Significantly Elevated Serum Lipase in Pregnancy with Nausea and Vomiting: Acute Pancreatitis or Hyperemesis Gravidarum?

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.

What Behind the Scene of Hyperemesis Gravidarum: An Article Review

“…In addition, there is a list of important markers included; Hematocrit, Amylase and lipase. the elevated amylase level is noted in about 10% of patients with HG (Johnson et al, 2015). Urine culture and sensitivity, this investigation is to exclude urinary tract infection (UTI), because it is common in pregnant lady and it is often associated with nausea and vomiting (Goodwin et al, 2008).…”

Jaundice and pregnancy

“…Serum lipase levels are commonly elevated in hyperemesis gravidarum -levels up to ten times normal have been reported in the absence of pancreatitis. 9 Antithrombin III levels may be useful to distinguish acute fatty liver of pregnancy from pre-eclampsia with haemolysis, elevated liver enzymes and low platelets. 10 Bile acid levels are not specific for intrahepatic cholestasis of pregnancy, being elevated in many hepatic disorders including nonalcoholic fatty liver disease.…”

Review article: Investigations and the pregnant woman in the emergency department – part 1: Laboratory investigations

“…Hyperemesis gravidarum has been reported to be associated with significantly elevated levels of lipase and amylase in the absence of clinical pancreatitis …”