Saturday, February 26, 2011

Alkaline phosphatase elevated - Bone origin or Liver origin?

The mnemonic was revealed when I got a patient with very high Alkaline phosphatase who had no clear cut evidence of bone / GI disease. So I read through the various tests to differentiate between ALP of Bone and Liver origin. There were various tests including GGT, Heat stability, Bone scan, Ct scan.... etc etc. But the point of Heat stability of ALP of liver origin has this interesting code:
Bone Burns first, Liver Lasts / LIVEs
Explanation : ALP of Bone origin is heat labile (Burns), while that of Liver origin is heat stable (Lasts / Lives).

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