super-high alk phos - any ideas why?
- 0Aug 11, '09 by AliRaeOkay, 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.
- 0Aug 11, '09 by AliRaeQuote from K.P.A.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'm not even a student yet but wonder if you've considered parasites?
What are endemic to babies origin? Plasmodium, Leishmania, Trypanosoma, trematodes,...?
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...