The levels of pancreatic digestive
enzymes, lysosomal
hydrolases, and
protease inhibitors were evaluated in
ascites fluid from 24 patients with
acute pancreatitis diagnosed as alcoholic,
gallstone-induced, or idiopathic. In this group the concentrations of
amylase (354 +/- 98 ng/ml), immunoreactive cationic
trypsinogen (1840 +/- 238 ng/ml), and immunoreactive
elastase 2 (1492 +/- 262 ng/ml) were greatly elevated in comparison to the corresponding serum values.
Enzyme levels in
ascites from the idiopathic
pancreatitis group tended to be higher than the levels from the other two groups. Activity of
acid phosphatase and
beta-glucuronidase was significantly higher in
ascites compared to serum in all groups. On the other hand, levels of immunoreactive
alpha 1-protease inhibitor and
alpha 2-macroglobulin in
ascites fluid were about half the average concentrations reported for normal serum. Significant amounts of tryptic
amidase activity (61.7 +/- 13.7 micrograms/ml) were observed, indicating a
trypsin-
alpha 2-macroglobulin complex. These data indicate an imbalance in the
protease-to-inhibitor ratio in
ascites fluid from patients with
acute pancreatitis. Coupled with elevated
ribonuclease activity (27.4 +/- 3.4 units), a positive
methemalbumin test in 23 of 24 patients (1.1 +/- 0.4 mg
hematin/100 ml), and an average
protein concentration of 4.0 +/- 0.2 g/100 ml, these observations demonstrate that abdominal paracentesis and the biochemical analyses of
ascites fluid provide useful information related to the biochemical events in
acute pancreatitis and may be useful in the diagnosis of difficult cases, but their predictive value of severity remains to be established.