Elevated Lipase

Normal lipase levels vary by assay.
Check your hospital’s reference range.

  • Lipase is an enzyme that catalyzes the breakdown of triglycerides.

  • Where can be lipase found:

    • Pancreatic acinar cells
    • Gastrointestinal (esophagus, stomach, duodenum, colon)
    • Heart
    • Liver
    • Lungs
    • Leukocytes

Causes [1]

Acute Pancreatitis

  • Lipase levels should exceed the upper limit of normal (ULN) by ≥3 times (sensitivity 64-100%; specificity 99-100%) [1, 2].

Other Pancreatic Causes

  • Pancreatic hyperenzymemia
  • Pancreatic cancer
  • Pancreas transplant rejection

Reduced Renal Clearance of Lipase

  • Acute or chronic renal failure
  • Macrolipase formation (associated with conditions such as celiac disease, Crohn’s disease, hypergammaglobulinemia, cirrhosis, multiple myeloma, systemic lupus erythematosus)

Hepatobiliary

  • Biliary atresia
  • Cholecystitis
  • Cholangitis
  • Hepatitis C
  • Hepatobiliary cancer
  • Liver necrosis
  • Post-endoscopic retrograde cholangiopancreatography (ERCP)

Gastrointestinal

  • Gastric perforation
  • Peptic ulcer disease
  • Bowel necrosis, perforation, or obstruction
  • Malignancy

Miscellaneous

  • Various medications have been implicated.
  • Chronic alcoholism
  • Intra-abdominal condition
    • Ruptured abdominal aortic aneurysm
    • Intra-abdominal hemorrhage
    • Peritonitis
  • Diabetic ketoacidosis
  • Critical illness
    • Intracranial hemorrhage
    • Traumatic brain injury
    • Multiple other conditions

Special Populations

Pediatrics

No unique pediatric-specific causes for an elevated lipase level.

Pregnancy

Hyperemesis gravidarum can cause an elevated serum lipase level [3].

  • First rule out pancreatitis, which can also cause vomiting.

Lab It Up Library

You order a battery of laboratory tests on your patient in the Emergency Department and few results are highlighted as abnormal in red. Why is it abnormal? Are you forgetting causes? The “Lab It Up” library helps Emergency Department clinicians to recall relevant differential diagnoses for abnormal laboratory results.

View the full Lab It Up Library list.

Lab It Up Library

You order a battery of laboratory tests on your patient in the Emergency Department and few results are highlighted as abnormal in red. Why is it abnormal? Are you forgetting causes? The “Lab It Up” library helps Emergency Department clinicians to recall relevant differential diagnoses for abnormal laboratory results.

View the full Lab It Up Library list.

Originally published August 14, 2023

References

  1. Hameed AM, Lam VW, Pleass HC. Significant elevations of serum lipase not caused by pancreatitis: a systematic review. HPB (Oxford). 2015 Feb;17(2):99-112. doi: 10.1111/hpb.12277. Epub 2014 Jun 3. PMID: 24888393
  2. Tenner S, Baillie J, DeWitt J, Vege SS; American College of Gastroenterology. American College of Gastroenterology guideline: management of acute pancreatitis [published correction appears in Am J Gastroenterol. 2014 Feb;109(2):302]. Am J Gastroenterol. 2013;108(9):1400-1416. doi:10.1038/ajg.2013.218. PMID 23896955
  3. Johnson A, Cluskey B, Hooshvar N, et al. Significantly elevated serum lipase in pregnancy with nausea and vomiting: acute pancreatitis or hyperemesis gravidarum?. Case Rep Obstet Gynecol. 2015;2015:359239. doi:10.1155/2015/359239. PMID 25709846

Citation

Lopes G. Lab It Up: Elevated Lipase. Academic Life in Emergency Medicine.  https://www.aliem.com/lab-it-up-elevated-lipase/. Published Aug 14, 2023.

Gabriella Lopes, MD

Gabriella Lopes, MD

Emergency Medicine Resident
Department of Emergency Medicine
University of California, San Francisco
Gabriella Lopes, MD

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