Infant with obstructive jaundice or what is the cause of ALP elevation?

We present a case of an infant born in the twenty-eighth week of pregnancy with elevated alkaline phosphatase (ALP). In addition to the

regular daily supplementation of vitamin D, calcium and phosphate an intramuscular injection of cholecalciferol was administered in the

age of three month because of persistent elevation of ALP. At the subsequent examination carried out because of failure to thrive mild

hypercalcemia, significant hypercalciuria and raised level of 25-OH-vitamin D3 were detected. During the further follow-up clinical and

laboratory signs of cholestasis appeared. The obstruction of the efferent bile ducts due to multiple cholelithiasis has been demonstrated

by MRCP. Considering persistent clinical and laboratory signs of cholestasis ERCP was performed and a stent has been inserted into

the bile duct at the specialized medical facility. During the subsequent follow-up regression of clinical problems and disappearance of

laboratory markers of cholestasis occurred.

In the subsequent discussion the utility of ALP as isolated parameter for the monitoring of the risk for metabolic bone disease of prematurity

development as well as for the management of this disease is argued about. At the same time the necessity of evaluation of

elevated ALP in the context of other laboratory and clinical findings is emphasized.

Keywords: alkaline phosphatase, metabolic bone disease of prematurity, obstructive icterus, cholelithiasis, vitamin D