Raised Alkaline Phosphatase in a 16 month old

My 16 month daughter was refered to a GI for low weight.  At the time of the appointment she had put on a rapid 1.25 lbs in 4 weeks based on a very high calorie diet.  

She had a blood test all of which came back normal except for a raised Alkaline Phosphatase.  I did not get the exact numbers, but it was "something they want to keep an eye on"  

I am assuming it is probably the significant and sudden increase in fat in her diet (in the form of Flax seed oil) that probably caused the elevated levels.  However, I have been unable to locate any literature that may point to what may be causing this.

[Kevin Pho, MD]

Hello - thanks for asking your question.

Causes of isolated alkaline phosphatase elevation include the following: partial bile duct obstruction, primary biliary cirrhosis (PBC), primary sclerosing cholangitis, adult bile ductopenia, and certain drugs such as androgenic steroids and phenytoin. Infiltrative diseases include sarcoidosis, other granulomatous diseases, and less often unsuspected cancer metastatic to the liver.  

Alkaline phosphatase levels also vary with age. Rapidly growing adolescents can have serum alkaline phosphatase levels that are twice those of healthy adults because of leakage of bone alkaline phosphatase into blood.

Obviously with a 16 month old, some of these possibilites would be less likely.  I agree with the recommendation for watching the alkaline phosphatase and to evaluate further if it rises.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Pratt.  Approach to the patient with abnormal liver function tests.  UptoDate, 2003.

FYI - I will be away from August 1-9th. I will look forward to answering your questions when I return.

[rhyanenrose]

Hi.  My 2 year old was losing weight also, among other symptoms.  They did a CBC and Chem 20 and found that he had an elevated alkaline phosphatase level too.  I was very high, like around 7000.

His ped would not give up trying to find out what the problem was.  Soon after getting very sick and still losing weight, we saw a ped GI who tested him for Celiac Disease.  One of his tests was positive and they did a small bowel biopsy.  Sure enough, he had Celiac disease.

Doctors ought to be very suspicious of Celiac if a young child is losing weight and has an isolated alk phos level like that.  I would seriously consider going to a ped GI and request testing for Celiac.  You can visit www.celiac.com for more information.

Other good sites are:

www.aafp.org/afp/980301ap/pruessn.html
(go to this website and at the bottom of the page, go to Table 3.  They talk about the alkaline phoshatase)

www.digestive.niddk.nih.gov/ddiseases/pubs/celiac/index.htm

Good luck and keep us posted.

rhyanenrose

[Briez]

Thought our experience might help.

My son is very sick -- though by his disposition you wouldn't know it. He has been undergoing lots of tests because of a high level of Phosphatase in his blood, which I understand generally indicates bone growth in adolescents. Or on the other side of the coin can indicate other diseases, especially in young children. My son's count was "astronomically high", which I understand may indicate bone or liver disease.

I feel lucky we found out so early. We only found out after 5 plus weeks of diarrhea and exhausting all possible solutions for the diarrhea. At about five weeks into the diarrhea -- after constant calls to his nurses -- they decided to do blood tests and then xrays of his knees & wrists and a urine test.

At first they thought Rickets, then they thought inflammation of the gut, but after further breakdown of the blood sample, which not all labs do, it is now looking like my son's medical problem is 1/4 liver and 3/4 bone.

Doctor said the expert at children's has seen a few cases like my son's and that once the diarrhea went away on its own, the Phosphatase levels also went away with no real explanation.

So my son will go in for blood work again soon and if the levels are still high, he'll need to see the specialist at Children's again to pinpoint the problem and discuss treatment.

Bottom line -- this is something you may want to keep after. I understand from our doctor that not all labs break down blood and discover there is a problem. If left untreated, could lead to more serious problems.

Good luck!

[Briez]

Just wanted to add that they are watching my son for weight & height drop off as well -- possibly linked to the Phosphatase issue.

[enj]

My son has had diarrhea, bellyache, and headaches for weeks.  All the blood tests are normal except for the alkaline phosphatase.  His pediatrician said it is off the charts.  Nobody seems to have an answer.  We're  very concerned and confused.

[Wad88]

A related discussion, Alkaline Phosphate levels are high in 15 month old infant was started.