Management of Elevated Lipase Levels

Diagnostic and Treatment Considerations

• The World Journal of Emergency Surgery recommends supportive care with intravenous fluids, pain management, and nutritional support with early oral feeding for mild acute pancreatitis 1
• The Journal of the National Comprehensive Cancer Network recommends holding immunotherapy and initiating high-dose steroids if pancreatitis is immunotherapy-related, and considering inpatient management for moderate acute pancreatitis 2
• For severe acute pancreatitis, the World Journal of Emergency Surgery recommends discontinue immunotherapy, aggressive fluid resuscitation, intensive care monitoring, and consider enteral nutrition via nasojejunal tube 1
• The American Gastroenterological Association, as published in Gastroenterology, recommends pancreatic enzyme replacement therapy (PERT) as the mainstay of treatment for exocrine pancreatic insufficiency (EPI), with an initial dose of 500 units of lipase/kg per meal 3
• The American Gastroenterological Association, as published in Gastroenterology, recommends dietary management for EPI, including high protein foods, avoiding very low-fat diets, and supplementing with fat-soluble vitamins (A, D, E, K) 3
• The European Society for Clinical Nutrition and Metabolism, as published in Clinical Nutrition, recommends treatment of hypertriglyceridemia to dramatically improve outcomes and prevent further pancreatic damage, and maintaining triglyceride levels below 12 mmol/L 5
• The European Society for Medical Oncology, as published in Leukemia, recommends that asymptomatic elevations in lipase may not require dose modification for TKI therapy-related elevated lipase, but symptomatic or severe elevations may require dose reduction or temporary discontinuation 6
• The World Journal of Emergency Surgery recommends monitoring lipase levels until normalization and following clinical symptoms and signs of improvement for acute pancreatitis 1
• The American Gastroenterological Association, as published in Gastroenterology, recommends evaluating reduction in steatorrhea and gastrointestinal symptoms, monitoring weight gain, muscle mass, and function, and annual assessment of micronutrient status and endocrine function (glucose, HbA1c) for exocrine pancreatic insufficiency 3
• The American Gastroenterological Association, as published in Gastroenterology, recommends bone density scan every 1-2 years for exocrine pancreatic insufficiency 3
• Untreated conditions causing elevated lipase, especially EPI, can lead to complications related to malabsorption and malnutrition, according to the American Gastroenterological Association, as published in Gastroenterology 3