Related Experiment Video

Updated: Apr 26, 2026

Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen
09:44

Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen

Published on: November 27, 2019

10.7K

Elevated Alkaline Phosphatase in Infants With Parenteral Nutrition-Associated Liver Disease Reflects Bone Rather Than

Prathima Nandivada1, Alexis K Potemkin1, Sarah J Carlson1

  • 1The Vascular Biology Program and Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.

JPEN. Journal of Parenteral and Enteral Nutrition
|August 10, 2014
PubMed

Insights

Elevated alkaline phosphatase (ALP) in infants with intestinal failure (IF) is often due to bone disease, not liver disease. This study shows bone-specific ALP is elevated in parenteral nutrition-associated liver disease (PNALD).

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Pediatric Endocrinology

Background:

  • Elevated serum alkaline phosphatase (ALP) in infants with intestinal failure (IF) can indicate parenteral nutrition-associated liver disease (PNALD) or metabolic bone disease (MBD).
  • Distinguishing the source of elevated ALP is crucial for accurate diagnosis and management in infants with IF.

Purpose of the Study:

  • To evaluate the diagnostic utility of serum ALP in identifying PNALD in infants with IF.
  • To differentiate between hepatic and bone-derived ALP in infants with PNALD by measuring tissue-specific levels.

Main Methods:

  • Retrospective review of 15 infants diagnosed with PNALD (defined by direct bilirubin >2 mg/dL).
  • Measurement of fractionated serum alkaline phosphatase (ALP), parathyroid hormone (PTH), vitamin D3, calcium, and phosphate levels.

Main Results:

  • In infants with PNALD, elevated total ALP was primarily due to significantly increased bone-specific ALP.
  • Liver-specific ALP levels remained within the normal range.
  • Associated metabolic bone disease markers (PTH, vitamin D3, calcium, phosphate) were within normal limits.

Conclusions:

  • Elevated ALP in infants with IF and PNALD is predominantly of bone origin, not hepatic.
  • Relying solely on elevated unfractionated ALP may misattribute liver disease when bone disease is the primary driver.
  • This suggests a need to consider bone-specific ALP assessment for accurate PNALD diagnosis.
Abstract

Keywords:
gastroenterologylife cycleneonatesnutritionparenteral nutritionresearch and diseases

More Related Videos

A Silver Nanoparticle Method for Ameliorating Biliary Atresia Syndrome in Mice07:48

A Silver Nanoparticle Method for Ameliorating Biliary Atresia Syndrome in Mice

Published on: October 13, 2018

7.1K
Inducing Acute Liver Injury in Rats via Carbon Tetrachloride CCl4 Exposure Through an Orogastric Tube06:12

Inducing Acute Liver Injury in Rats via Carbon Tetrachloride CCl4 Exposure Through an Orogastric Tube

Published on: April 28, 2020

11.0K

Related Concept Videos

Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test01:22

Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test

In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
271
Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
405
Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
954
Inborn Errors of Metabolism01:20

Inborn Errors of Metabolism

Phenylketonuria (PKU) is a protein metabolism disorder characterized by high blood levels of the amino acid phenylalanine. This results from a mutation in the gene responsible for phenylalanine hydroxylase, an enzyme that converts phenylalanine into tyrosine. When this enzyme is deficient, phenylalanine builds up in the blood, leading to symptoms such as vomiting, rashes, seizures, growth deficiency, and severe mental retardation. An early diagnosis and a diet restricting phenylalanine intake...
1.1K
Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

Pharmacokinetics in Pediatric Patients: Drug Distribution

Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
544
Parentral Nutrition: Centeral and Peripheral Parental Nutrition01:27

Parentral Nutrition: Centeral and Peripheral Parental Nutrition

Parenteral Nutrition (PN) delivers essential nutrients directly into the bloodstream, bypassing the digestive system. It is commonly used for individuals with severe digestive disorders or conditions that prevent normal nutrient absorption.
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
2.0K