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Hyperamylasemia Following Lipid Resuscitation: Pancreas or Parotid?

Weinberg, Guy MD

doi: 10.1213/ANE.0b013e318263c924
Letters to the Editor: Letters & Announcements
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Department of Anesthesiology University of Illinois and Jesse Brown VA Medical Center Chicago, Illinois guyw@uic.edu(Weinberg)

Conflicts of Interest: Dr. Weinberg holds a US patent related to lipid infusion for treatment of poisoning and is cofounder of ResQ Pharma, LLC.

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To the Editor

The case report by Marwick et al.1 has become important to the literature of lipid resuscitation for demonstrating efficacy in reversing severe local anesthetic toxicity while illustrating the risk of recurrent toxicity after initial treatment success. Their patient experienced both generalized seizures and cardiovascular collapse. He later developed asymptomatic hyperamylasemia and the authors suggested this could indicate pancreatic injury, a recognized complication of chronic hyperlipemia. However, this effect has not been reported in other published cases of lipid resuscitation. Graham et al.2 reported increased amylase in 71% of patients having generalized seizures and speculated that in the absence of abdominal symptoms, this likely represents increased salivary amylase isozyme. Moreover, increased salivary amylase is known to occur after a wide range of stressors including trauma,3 cardiac surgery,4 acidosis,5 and β-adrenergic stimulation.6 It is also associated with cancer,7 acute illness,8 and even tracheal intubation.9 Hence, the presumption of pancreatic origin for hyperamylasemia is unfounded without isozyme analysis, especially when the patient has had convulsions, cardiac arrest, tracheal intubation, pressor therapy, or as in this case,1 all of these factors. We therefore recommend that isozyme analysis be performed in future cases of lipid resuscitation when hyperamylasemia occurs. Specifying the origin of amylase as either pancreatic or salivary will help guide appropriate clinical management.

Guy Weinberg, MD

Department of Anesthesiology

University of Illinois and Jesse Brown VA Medical Center

Chicago, Illinois

guyw@uic.edu

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REFERENCES

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9. Iakushenko NL, Nagobade DT, Kopeika UE, Mikhel'son MO. Changes of salivary alpha amylase activity as an indicator of adrenergic activity in response to laryngoscopy and endotracheal intubation [in Russian]. Anesteziol Reanimatol 2011;3:29–33
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