Acute
alcoholic pancreatitis is a clinical diagnosis made in patients who have acute upper
abdominal pain,
emesis, and
hyperamylasemia soon after ingesting alcohol. We sought to determine whether the clinical diagnosis of
pancreatitis was supported by elevated serum levels of pancreatic
isoamylase, currently the most specific test for
pancreatitis. Serum
lipase levels and urinary
amylase/
creatinine clearance ratios were examined for comparison with pancreatic
isoamylase concentrations. Potential sources for salivary isoamylasemia were explored with
technetium scans of the parotid glands. Of 19 patients with a clinical diagnosis of
alcoholic pancreatitis, 16 had elevated levels of pancreatic
isoamylase, and 17 had salivary
hyperamylasemia. The diagnostic specificity of the serum
lipase level or the urinary
amylase/
creatinine clearance ratio was excellent compared to that of the pancreatic
isoamylase level. Three patients had elevated levels of salivary
isoamylase only. Scans of the parotid glands in the study group revealed significantly higher uptake values than scans in nonalcoholic control subjects, suggesting one possible source of elevated levels of salivary
isoamylase.