Amylase blood

Pancreatic amylase is so far the only amylase which has been found to be completely inactive in the absence of certain anions.39,60 Other amylases of animal origin, such as salivary and blood amylases, show increased activity in the presence of electrolyte61,62 and, when highly purified, may also be found to require the presence of certain anions for their activation. Kneen and coworkers68,64 have reported the purifica-... 

El. Elman, R., Arneson, N., and Graham, E. A., Value of blood amylase estimations in the diagnosis of pancreatic disease. Arch. Surg. 19, 943-967 (1929). 

Certain biochemical changes are useful in diagnosing pancreatitis pancreatic damage results in amylase and lipase being released into the blood. Amylase concentration rises over 3-12 hours and returns to normal in three to four days. The rise in lipase is slower and restoration of normal blood levels takes longer. 

Blood arterial pH - increased Blood cholinesterase - decreased Blood creatine kinase (CK) - increased Blood amylase - increased Blood glucose - increased Blood WBC - increased (leukocytosis)... 

Blood amylase - increased Blood bilirubin - increased [ 1 ]... 

Macroamylase formation may cause elevation in blood amylase that leads to inaccurate diagnosis of pancreatitis Dextrans... 

Amylase enters the blood largely via the lymphatics. An increase in hydrostatic pressure in the pancreatic ducts leads to a fairly prompt rise in the amylase concentration of the blood. Neither an increase in volume flow of pancreatic juice nor stimulation of pancreatic enzyme production will cause an increase in senm enzyme concentration. Elevation of intraductal pressure is the important determinant. Stimulation of flow in the face of obstruction can, however, augment the entry of amylase into the blood, as can disruption of acinar cells and ducts. A functional pancreas must be present for the serum amylase to rise. Serum amylase determination is indicated in acute pancreatitis in patients with acute abdominal pain where the clinical findings are not typical of other diseases such as appendicitis, cholecystitis, peptic ulcer, vascular disease or intestinal obstruction. In acute pancreatitis, the serum amylase starts to rise within a few hours simultaneously with the onset of symptoms and remains elevated for 2 to 3 days after which it returns to normal. The peak level is reached within 24 hours. Absence of increase in serum amylase in first 24 hours after the onset of symptoms is evidence against a diagnosis of acute pancreatitis (76). 

Opiates and other narcotics and analgesic drugs may unpre-dicatably elevate the serum amylase. The elevation may last up to 24 hours. Therefore it is important that blood for amylase determination be drawn before giving the patient analgesic drugs for pain. Elevation of the enzyme in peritoneal fluid is strong... 

The rate of urine amylase excretion is a sensitive reflection of the amylase released into the blood. The urine amylase remains abnormal 1-2 weeks after the serum returns to normal because the renal clearance of amylase rises 3-fold in acute pancreatitis and takes 1-2 weeks to return to normal. In pancreatitis, a number of investigators have reported a higher percentage of urinary amylase elevations, as contrasted with serum amylase elevations, particularly when the urinary amylase output over an interval is measured. Random urine collections for one, two and 24 hours are 792-4264 (2926 1074 S.D.) units per 24 hours. However, the wide range of normals make interpretation of results difficult. Of 107 patients with elevated serum or urine amylases, 16 were found to have a normal pancreas at operation (78). 

The goals of treatment for acute pancreatitis include (1) resolution of nausea, vomiting, abdominal pain, and fever (2) ability to tolerate oral intake (3) normalization of serum amylase, lipase, and white blood cell count and (4) resolution of abscess, pseudocyst, or fluid collection as measured by CT scan. 

Monitoring Perform periodic complete blood counts and clinical chemistry tests. Monitor serum amylase levels in those individuals who have a history of elevated amylase, pancreatitis, ethanol abuse, who are on parenteral nutrition, or who are otherwise at high risk of pancreatitis. 

Serum amylase, bilirubin, cholesterol, lipase, and triglyceride levels blood glucose level CBC CD4+ cell count and liver function test results... 

After IV administration it is enzymatically metabolised by endogenous amylase. The smaller fragments undergo rapid glomerular filtration. The 6% iso-oncotic infusion solution allows precise blood volume control and leads to an effective stabilisation of blood volume, whereas 10% hyperoncotic infusion solution has a greater expansive volume effect. It improves plasma volume for 24 hours or more. 

When HES is infused, the smaller molecules are excreted by the kidneys, while the larger molecules are metabolised by o-amylase, and taken up by the reticuloendothelial system (RES) and the skin. Even though HES molecules disappear from the blood within 10-72 hours, dependent on their molecular weight, they can be detected in the RES for at least one month. Anaphylactic reactions to HES are lower than with other colloids and they have minimal effects on coagulation. Controversy exists regarding the use of HES in patients with renal insufficiency, and dose recommendations are based on the risk of renal tubular overload and the influence on haemostasis (possible decrease in factor Vll/von Willebrand factor). The risk is greater with the higher MW solutions, and appears to be lower with the new HES 130/0.4. 

Chapters 17 through 21 deal with carbohydrate-enzyme systems. Hehre presents some new ideas on the action of amylases. Kabat presents some new immunochemical studies on the carbohydrate moiety of certain water-soluble blood-group substances and their precursor antigens. Hassid reviews the role of sugar phosphates in the biosynthesis of complex saccharides. Pazur and co-workers present information obtained by isotopic techniques on the nature of enzyme-substrate complexes in the hydrolysis of polysaccharides. Gabriel presents a common mechanism for the production of 6-deoxyhexoses. An intermediate nucleoside-5 -(6-deoxyhexose-4-ulose pyrophosphate) is formed in each of the syntheses. 

The effects of pancreatic exocrine supplements (four capsules with meals, two with snacks each capsule containing lipase 10 000 units, protease 37 500 units, amylase 33 200 units) on glucose metabolism have been studied in a 2-week parallel, randomized, placebo-controlled trial in 29 patients with chronic pancreatitis who had stool fat excretion of over 10 g/day, 18 of whom were diabetic and 15 of whom were malnourished (902). There were major problems with blood glucose control in 28 of the 29 patients. 

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