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Teachable Moment
Less Is More
May 2018

Unnecessary Repeat Enzyme Testing in Acute Pancreatitis: A Teachable Moment

Author Affiliations
  • 1Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
  • 2Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
JAMA Intern Med. 2018;178(5):702-703. doi:10.1001/jamainternmed.2018.0106

A 61-year-old man presented to the emergency department with acute onset of nausea and severe abdominal pain that radiated to the back. He did not drink alcohol and had never had these symptoms previously. In the emergency department, his blood pressure was 152/71 mm Hg; heart rate, 45 beats/min; temperature, 36°C; and respiratory rate, 20 breaths/min. Abdominal examination noted epigastric tenderness. Initial laboratory test results revealed a serum lipase level greater than 12 000 U/L (reference range, 8-78 U/L). Hematocrit was 45% (reference range, 42%-55%); white blood cell count was 12 200 cells/mm3 (reference range, 4500-11 000 cells/mm3); but calcium levels, triglyceride levels, renal chemical findings, and liver function test results were all within normal limits. Abdominal ultrasonography demonstrated no biliary obstruction or stones. He was admitted for the management of acute pancreatitis, given intravenous fluids and morphine, and ordered to receive nothing by mouth.

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