Lipase

Order Code

---

2124

Preferred Specimen

---

Collect 2 mL of serum using an SST tube. Allow the sample to clot upright for a minimum of 30 minutes, then centrifuge within 2 hours of collection. Refrigerate promptly.

ContainerType

---

Serum separator tube

Alternate Specimen Requirements

---

Obtain 2 mL of serum in a plain red top tube. Let the sample clot in an upright position for at least 60 minutes before centrifuging. Transfer the serum into a plastic transport tube within 2 hours of collection and label clearly as serum from a plain red top tube. Refrigerate.

Minimum Volume

---

Adult: 1 mL serum
Pediatric: 0.2 mL serum (does not allow for repeat or
additional testing).

Transport Temperature

---

Refrigerated

Expected Turnaround Time

---

1 day

Specimen Stability

---

1 week room temperature; 1 week refrigerated; 1 year frozen

Methodology

---

Roche COBAS enzymatic/colorimetric

Rejection Criteria

---

• Gross hemolysis

Overview

---

Lipases are crucial enzymes involved in the digestion, transport, and metabolism of triglycerides. Pancreatic lipase, produced mainly by pancreatic acinar cells, is secreted into the small intestine where it breaks down triglycerides into free fatty acids. Additional lipase types include colipase (also pancreatic in origin and necessary for pancreatic lipase activity), lipoprotein lipase (found in vascular endothelium and vital for triglyceride metabolism), and lingual lipase (produced by salivary glands). Serum lipase primarily reflects pancreatic lipase activity.

Pancreatitis, a frequently encountered condition with over 210,000 annual hospital admissions in the U.S., is characterized by elevated blood levels of lipase and amylase due to inflammation of the pancreas. In acute pancreatitis, levels of both enzymes typically rise to at least three times the upper normal limit, independent of the cause—such as alcohol use, gallstone obstruction of the pancreatic duct, or certain medications. The increase in lipase generally occurs shortly after amylase and remains elevated longer before returning to baseline.

Clinical Significance

---

• Evaluation of symptoms consistent with a pancreatic disorder, such as severe abdominal pain, nausea and vomiting, fever, and loss of appetite
  • Elevation ≥3 times the upper limit of normal (lipase or amylase) is consistent with the diagnosis of acute pancreatitis.
  • Elevation typically resolves over 5-7 days, but may take as long as 14 days.
  • Helpful in clinical situations where the patient presents several days after symptom onset, by which time amylase may have returned to baseline yet lipase is still elevated.
• Follow effectiveness of treatment for pancreatitis and other pancreatic diseases (although following symptomatic improvement is usually sufficient, unless evaluating for symptoms that do not resolve)
• Helpful in distinguishing cases of macroamylasemia, parotitis, and some carcinomas where amylase is elevated yet lipase remains normal

Interpretative Information

---

Lipase may be elevated due to:

• Inflammation of the pancreas
  • In Western countries, 80% of acute pancreatitis is caused by gallstones (transient obstruction of the ampulla of Vater) and alcohol (Banks, 2006).
  • Drugs known to cause pancreatic inflammation include aspirin, azathioprine, chlorthalidone, cimetidine, clozapine, corticosteroids, dideoxyinosine, fluvastatin, isoniazid, loop and thiazide diuretics, mirtazapine, NSAIDs, oral contraceptives, sulfamethoxazole, and exenatide.
  • Nondrug causes include hypertriglyceridemia (>1000 mg/dL), hypercalcemia, trauma, pancreatic tumors, viruses (ie, paramyxovirus, Epstein-Barr virus, cytomegalovirus), and idiopathic.
• Pancreatic tumors
• Chronic renal insufficiency
• Damage to the intestine (ie, bowel infarction or perforation)
• Acute cholecystitis
• Diabetic ketoacidosis
• Certain drugs (eg, opiates and cholinergics causing sphincter of Oddi spasm)
• Trauma
• Postendoscopic retrograde cholangiopancreatography (ERCP)

Lipase may be decreased due to:

• Permanent damage to pancreas (eg,chronic pancreatitis due to alcoholism, cystic fibrosis)
• Drugs: Secretin, hydroxyurea

Limitations

---

• Elevation does not correlate to severity of pancreatitis.
• Levels may be normal in acute pancreatitis in those patients with a history of recurrent pancreatitis.
• Levels are elevated in 55% of patients with primary biliary cirrhosis (Fonseca, 1986).
• Levels are elevated in posthemodialysis patients (felt due to heparin-induced lipolytic activity) (Vaziri, 1988).
• Elevations of lipase can be seen in patients with end-stage renal disease (ESRD) and chronic renal failure (Soundararajan, 2013)

References

---

Diagnostic Role

---

In acute pancreatitis, serum lipase typically increases ≥3x the upper limit of normal, and can be significantly higher. The elevation in lipase typically follows that of amylase and persists longer, decreasing over 5-7 days. In nonpancreatic conditions, such as renal failure or bowel obstruction, the total rise in lipase is not as great, but may persist in the serum for a longer period of time.

Test Setup Days

---

Monday through Friday PM shift

CPT

---

83690 LOINC: 3040-3

Reference Range

---

13-60 U/L

UNIT CODE	UNIT CODE NAME	ANALYTE	GENDER	AGE	REFERENCE RANGE	Units of Measure
2124	LIPASE	LIPASE	NOT SPECIFIED	ALL	13-60	U/L
2124	LIPASE	LIPASE	MALE	ALL	13-60	U/L
2124	LIPASE	LIPASE	FEMALE	ALL	13-60	U/L