Page 72 - JCBP-2-1

Journal of Clinical and
Basic Psychosomatics Elevated serum amylase in MDD patient

In this case, we report an unexplained, abnormal In the morning on the 3 day, the patient’s temperature
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increase in serum amylase in a critically ill patient without dropped (axillary temperature 37.6–37.8°C), and the ECG
the above-mentioned related factors. showed the following results: (i) Sinus rhythm, (ii) QTc
prolongation (485), and (iii) intraventricular conduction
2. Case presentation block. The chest CT showed no inflammation. Following the
The patient was a 63-year-old male with no history of mental cardiologist’s recommendation, we conducted reviews of
illness and was admitted to the hospital due to experiencing the patient’s myocardial function at 06:00, 09:40, and 14:40.
gradual low mood and pessimism for the past 6 months. At 09:40, we also performed a comprehensive biochemical
Six months ago, the patient began to exhibit symptoms of examination to understand the patient’s electrolyte level.
low mood, thought inhibition, and insomnia. Two months Unexpectedly, we discovered that the serum amylase was
later, he developed suicidal thoughts, decreased interest, as high as 884 U/L (reference range 0–100 U/L), but the
reduced speech, fatigue, and feelings of being monitored. CT scan of the entire abdomen that afternoon reported no
Over time, the patient’s symptoms worsened, and he obvious abnormalities in the pancreas.
began experiencing soliloquize, hallucinations, feelings of From admission until noon on the 3 day, the patient
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insecurity, and one episode of subliminal stupor at home. remained in a state of sub-stupor, with clear consciousness
Four months later, the patient started taking sertraline but tension, passivity, closed eyes, and mutism. However,
(increased to 200 mg/morning) and olanzapine (increased when the patient’s daughter visited at noon on the
to 5 mg/night) until his hospitalization. On admission to 3 day, his symptoms underwent a dramatic change,
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the hospital, the patient presented with a week-long history and his nervousness was relieved. With the support of
of cough and yellow sputum and had self-administered his family, he was able to communicate with the doctor
cefprozil 0.25 mg twice a day for 3 days. and denied experiencing any physical discomforts,
On the day of admission, the patient underwent blood including chest pain and abdominal pain, since the
routine and biochemical examinations (Table 1). The ECG fever. The patient’s symptoms, signs, and examination
examination showed a heart rate of 74 bpm with a sinus did not support a diagnosis of acute pancreatitis. On the
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rhythm. There was counterclockwise rotation, Embryonic 5 day, the patient began to consume small amounts of
R wave, abnormal Q wave (in leads V 4–V 6), intraventricular food and walked in the ward with the assistance of his
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block, and a possibility of old side wall heart infarction. In wife. After taking venlafaxine on the 6 day, the patient’s
addition, the chest CT revealed inflammation in the right depressive symptoms gradually improved, and various
middle lobe. Initially, the patient was conscious and able blood biochemical indicators showed gradual recovery.
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to walk into the ward independently. However, shortly Troponin I was normal on the 8 day and serum amylase
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after interacting with the doctors and nurses, he became level was normal on the 16 day.
nervous and passive and started exhibiting mutism while
tightly closing his eyes. Eventually, he developed a state of 3. Discussion
sub-stupor (Table 2 for the medications administered to The patient’s serum amylase was abnormally elevated, but
the patient after admission). there were no signs of pancreatitis or any relevant imaging
On the 2 day, the patient developed hyperthermia findings. The previous studies have suggested that elevated
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with a rectal temperature of 40°C, accompanied by serum amylase in the absence of pancreatic damage
[6]
excessive sweating and tremor, at night. The heart rate indicates a high risk of death in patients . In addition,
was 160 beats/min, the blood pressure was 160/90 mmHg, this patient went through a dangerous stage with unstable
and the blood oxygen saturation was 90%. Consequently, vital signs and myocardial damage. Consequently, we were
the doctor decided to stop all medications that night keen to investigate the cause of the elevated serum amylase
and provide supportive treatment. A series of blood level. There can be several reasons for such an increase.
tests were conducted (Table 1). The electrocardiogram After reviewing previous studies and reconsidering the
revealed the following results: (i) Sinus rhythm, (ii) non- patient’s case, we initially explored the possible causes of
specific intraventricular conduction delay, (iii) electrical the elevated amylase level, including pneumonia, cardiac
[3]
right axis deviation, and (iv) abnormal Q waves in leads conditions, and medication usage .
V 4–V 6, indicating myocardial injury. After an emergency The patient had suffered from coughing with sputum
consultation with the cardiology department, no specific for a week before admission. On the day of admission, a
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treatment for myocardial injury was recommended. CT showed pneumonia, but on the 3 day of admission
However, it was advised to perform a dynamic review of (the day when elevated serum amylase was found), the
myocardial enzymes. CT scan did not report pneumonia. Considering the time

Volume 2 Issue 1 (2024) 2 https://doi.org/10.36922/jcbp.0550