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Alkaline Phosphatase > 2000 U/L in an Infant With Stool Changes: A Case Report
1Department of Family Medicine, Loma Linda University, Loma Linda, CA, USA.
Insights
Transient hyperphosphatasemia (TH) is a benign, self-limiting condition in young children. This case highlights how elevated alkaline phosphatase (ALP) levels can resolve with monitoring, avoiding unnecessary tests.
Area of Science:
- Pediatrics
- Clinical Biochemistry
Background:
- Transient hyperphosphatasemia (TH) is a benign condition characterized by elevated serum alkaline phosphatase (ALP) in healthy children.
- It typically affects those under 5 years old and resolves spontaneously within months.
Observation:
- A 12-month-old girl presented with pale stools and incidentally elevated ALP (2379 IU/L).
- Physical examination revealed a small anal fissure; other findings were unremarkable.
- Differential diagnoses included serious conditions like biliary atresia and liver disease.
Findings:
- Extensive laboratory tests (CBC, CMP, calcium, phosphate, etc.) and liver ultrasound were normal.
- The diagnosis of TH was confirmed.
- ALP levels normalized within 2 months during clinical observation.
Implications:
- This case underscores the importance of recognizing TH to prevent unnecessary diagnostic workups in children.
- Awareness of TH can lead to cost savings and reduced patient anxiety.
- Management involves clinical observation and serial ALP measurements, confirming its benign, self-limiting nature.
Abstract:
Transient hyperphosphatasemia (TH) is a benign condition observed among healthy infants and children < 5 years old. It is characterized by an elevation in serum alkaline phosphatase (ALP) in the absence of other signs of organ disease. Prognosis is excellent, and ALP levels stabalize within 4 months. The aim of this case report is to promote broader awareness of TH so further unnecessary workup is avoided. The patient was a 12-month-old girl who presented with pale stools, a single episode of bloody stool, and elevation (incidentally found) in her ALP of 2379 IU/L. A small anal fissure was present, and the remainder of her physical examination was typical. The differential diagnosis included biliary atresia, liver disease, bone disease, and TH. Further testing was typical and included complete blood count (CBC, consisting of hemoglobin, hematocrit, white blood cell count, and platelet count), comprehensive metabolic panel (CMP, consisting of glucose, creatinine, BUN, electrolytes, and liver function markers), calcium, phosphate, parathyroid hormone, gamma-glutamyl transferase, and 25-hydroxy vitamin D. Liver ultrasound was also typical without evidence of biliary atresia. The diagnosis of TH was made. The patient was monitored clinically. Repeat blood work was completed 2 months later, with ALP levels returning to the typical range. Overall, TH is a benign self-limiting condition that can be managed by observation and serial measurement of ALP without further unnecessary investigations.
