title: 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.
authors.affiliation: Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, SL-11, Tulane School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
authors.forename: Amanda
authors.identifier: 0000-0002-7106-8139
authors.initials: A
authors.lastname: Johnson
authors.affiliation: Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, SL-11, Tulane School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
authors.forename: Bethany
authors.identifier: 0000-0002-7025-444X
authors.initials: B
authors.lastname: Cluskey
authors.affiliation: Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, SL-11, Tulane School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Hooshvar
authors.affiliation: Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, SL-11, Tulane School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
authors.forename: Daphne
authors.initials: D
authors.lastname: Tice
authors.affiliation: Department of General Surgery, Tulane School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
authors.forename: Courtney
authors.identifier: 0000-0001-9792-9892
authors.initials: C
authors.lastname: Devin
authors.affiliation: Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, SL-11, Tulane School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Kao
authors.affiliation: Tulane-Lakeside Hospital, 4700 S I 10 W. Service Road, Metairie, LA 70001, USA.
authors.forename: Suhalia
authors.initials: S
authors.lastname: Nawabi
authors.affiliation: Department of General Surgery, Tulane School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Jones
authors.affiliation: Department of Anesthesiology, Tulane School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
authors.forename: Lihua
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, SL-11, Tulane School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
authors.forename: Chi
authors.identifier: 0000-0001-8995-5329
authors.initials: C
authors.lastname: Dola