title: Elevated Alkaline Phosphatase in Children: An Algorithm to Determine When a "Wait and See" Approach is Optimal.
abstract: Due to the possibility of underlying hepatobiliaryor bone diseases, the diagnostic work up of a child with elevated alkaline phosphatase (AP) levels can be quite costly. In a significant proportion of these patients, elevated AP is benign, requiring no intervention: hence, known as transient hyperphosphatasemia (THP) of infants and children. A 27-month old previously healthy Caucasian female was found to have isolated elevation of AP four weeks after the initial symptoms of acute gastroenteritis. One month later, when seen in hepatobiliary clinic, signs and symptoms of gastrointestinal, hepatobiliary, or bone disease were absent and physical examination was normal. The diagnosis of THP was made, and, as anticipated, AP levels normalized after four months. Using this case as an example, we suggest an algorithm that can be utilized as a guide in a primary care setting to arrive at the diagnosis of THP and avoid further tests or referrals.
authors.affiliation: Division of Pediatric Education and Pediatric Gastroenterology, Hepatology and Nutrition, University of Florida, PO Box 100296, Gainesville, Florida 32610-0296, USA.
authors.forename: Jaclyn L
authors.initials: JL
authors.lastname: Otero
authors.forename: Regino P
authors.initials: RP
authors.lastname: González-Peralta
authors.forename: Joel M
authors.initials: JM
authors.lastname: Andres
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Jolley
authors.forename: Don A
authors.initials: DA
authors.lastname: Novak
authors.forename: Allah
authors.initials: A
authors.lastname: Haafiz
keywords: 25-OH-vitamin-D; abnormal liver enzymes; gamma-glutamyl transferase; hyperphosphatasemia