Nurses Helping Nurses
allnurses Network: Central | Jobs | Books | Newsletter
allnurses: A Nursing Community for Nurses
Home General News Blogs Articles Students Region Specialty Degrees F.A.Q.
PICU Nursing (Pediatric) /

super-high alk phos - any ideas why?



Did You Know?
allnurses is the largest community for nurses on the web. We now have over 388,340 members! Join today to network with other nurses, laugh, share, and much more.

Aug 11, 2009 09:53 AM

super-high alk phos - any ideas why?

by AliRae

Okay, my newest what-on-earth-is-going-on-here from the ship in West Africa ...

We have a little cleft lip / palate baby who was admitted through our feeding program. She's 4.5 months old, and she was admitted almost 3 weeks ago at 3.24 kg. She's now 3.33 kg, despite lots and lots of feedings.

The other day, a new doc was examining her, probably a little more thoroughly than she's been examined in the past (since we don't do much in the way of workups when a skinny baby has an OBVIOUS reason for not gaining weight like a lip/palate) ... it turns out she has a huge liver, so we sent labs. Here's where it gets interesting ...

Babe has an alk phos of 2228. Her ALT and AST are up too, somewhere in the 50-80 range (I cant remember exactly) and get GGT is normal. Lab was trying to run a calcium on the tiny little sample we gave them when I left, so I'm not sure what it is.

Mama is negative for HepB/C and HIV, but we didn't test baby because we didn't want to take that much blood if we didn't have to.

Other than Paget's disease, which would be kind of unlikely in such a small one, and we're not seeing any bone deformities, we're kind of stumped.

Anyone?


Share

Search Tags
None
Top

 
Advertisement
Sponsored Links
 
Reply
5 Comments
No. 1
from K.P.A.
Old Aug 11, 2009, 11:53 AM

Default Re: super-high alk phos - any ideas why?
I'm not even a student yet but wonder if you've considered parasites?
What are endemic to babies origin? Plasmodium, Leishmania, Trypanosoma, trematodes,...?
Top

1 Reader Gave Kudos
 
No. 2
from AliRae
Old Aug 11, 2009, 02:50 PM

Default Re: super-high alk phos - any ideas why?
Originally Posted by K.P.A. View Post
I'm not even a student yet but wonder if you've considered parasites?
What are endemic to babies origin? Plasmodium, Leishmania, Trypanosoma, trematodes,...?
Hm .... good point. Interestingly enough, we just had a patient who was discharged following a course of treatment for mucocutaneous leishmaniasis! First I had ever heard of it .... Baby is afebrile and negative for malaria on a smear. I'm figuring it's not trypanosoma, since she's completely symptom-free clinically with no swollen nodes. And most of the flukes come about my swimming in infested waters or eating infested foods, neither of which my little darling has quite gotten to yet in her development. =)

I love the thinking though ... now that you've got me on this path of thought, the malaria does seem like the most likely parasitic cause, but we just routinely test for that if there's anyhting else going on, so we had already ruled it out. She's too young to have built up SUCH a massive amount of parasite, too, since a good portion of her life has been spent as an inpatient in our feeding center, which is a relatively well climate-controlled environment.

It's a tricky one...
Top
 
No. 3
from K.P.A.
Old Aug 11, 2009, 04:48 PM

Default Re: super-high alk phos - any ideas why?
One more parasite. Pretty common worldwide. T gondii. Congenital toxoplasmosis.
Cleft palate, swollen liver, swollen spleen....If mother is available, you could test her.
I'm in way over my head here, but curious.
-Katz
Top
 
No. 4
from PICNICRN
Old Aug 11, 2009, 05:16 PM

Default Re: super-high alk phos - any ideas why?
Rickets???
Top
 
No. 5
from morte
Old Aug 11, 2009, 05:58 PM

Default Re: super-high alk phos - any ideas why?
http://www.medscape.com/viewarticle/413584
perhaps it is genetic?.....
Top
 
Reply




Thread Tools


Who's Online
383 members
4,342 guests
4,725

1

Interesting article on ThedaCare's Collaborative Care Model

4

Possible breakthrough regarding MS

52

16th Philly area hospital to stop delivering babies: Mercy...

7

Really interesting article on Indian open hearts

4

High-Tech Pump Does What Her Heart Can't

2

Air Force RN Force RN Found Not Guilty

17

Hospital Falters as Refuge for Illegal Immigrants

6

California Imposes Stricter Rules Regarding Drug Abuse In...

40

Are older nurses being forced out of the profession?

3

An outlook in California?



1

Society Needs Care Too

12

Why am I doing this, anyway?

2

Nurse Heal Thyself

9

My Papa, why I am the nurse I am today.

17

I made it through

11

An angel's gaze

15

A Sister Never Forgets

16

Ruby's Marbles

37

What Do Operating Room Nurses Do?

14

My Little Old Jedi

20

I love this job......

23

"I hear voices"

19

Preventing FRUTI (Foley Related Urinary Tract Infection) in...

24

Error and Attitude

10

It's Just a Shower





Currently Reading This Page: 1 (0 members & 1 guests)

Interested in the hottest topics of the week? Subscribe to the Nurse-zine Newsletter.
Enter email address: