Pancreatic Enzymes: Lipase Wins, Amylase Is Overrated, and DKA Fakes Pancreatitis
Pancreatic Enzymes: Lipase Wins, Amylase Is Overrated, and DKA Fakes Pancreatitis One enzyme is enough for diagnosis. The other one misleads you. And the magnitude doesn't predict severity. Lipase vs. Amylase: Lipase Wins Lipase is the preferred test for diagnosing acute pancreatitis. It's more sensitive (82–100%) and more specific (82–99%) than amylase. It rises within 4–8 hours, peaks at 24 hours, and remains elevated for 8–14 days (longer than amylase). Current ACG guidelines recommend lipase as the sole enzymatic criterion— amylase adds nothing and is no longer recommended as a standalone test for pancreatitis. Acute pancreatitis is diagnosed when 2 of 3 criteria are met: (1) characteristic abdominal pain, (2) lipase ≥3× upper limit of normal, (3) characteristic findings on imaging. Most cases can be diagnosed without imaging if pain + lipase are both positive. The Pitfalls 1. Amylase Has Too Many Non-Pancreatic Sources Amylase is produced by the salivary glands, ...