Reinterpretation of hyperamylasemia in diabetic coma.

Serum enzyme activity was sequentially determined in 10 consecutive patients with diabetic ketoacidosis, of whom all had increased -glucuronidase activity, eight had increased amylase activity, and four had increased acid phosphatase activity. Activity of amylase and that of the two lysosomal enzymes were poorly correlated, irrespective of whether peak activities or activities of all samples were considered. Of 37 cases with acute viral hepatitis, serum -glucuronidase activity was increased in 33 and amylase activity in four, and the correlation between the two was poor. Study of normal human liver showed that the ratio of its mean enzymatic activity to the upper normal limit for serum was less than 1.0 for amylase, and approximately 80 and 6000 for acid phosphatase and -glucuronidase, respectively. The hepatocyte cannot be the source of an increased serum amylase activity, and we question whether lysosomes are concerned in its release from other tissues.