Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (676 page)

   Osteomyelitis.

   Late pregnancy; reverts to normal level by 20th day postpartum.

   Children <10 years of age and again during prepubertal growth spurt may have three to four times adult values; adult values are attained by age 20.

   Administration of ergosterol.

   Hyperthyroidism.

   Transient hyperphosphatasemia of infancy

   Hodgkin disease.

   Healing of extensive fractures (slightly).

   Liver disease

   Any obstruction of the biliary system (e.g., stone, carcinoma, primary biliary cirrhosis) is a sensitive indicator of intrahepatic or extrahepatic cholestasis. Whenever the ALP is elevated, a simultaneous elevation of 5′-nucleotidase (5′-N) establishes biliary disease as the cause of the elevated ALP. If the 5′-N is not increased, the cause of the elevated ALP must be found elsewhere (e.g., bone disease).

   Liver infiltrates (e.g., amyloid or leukemia)

   Cholangiolar obstruction in hepatitis (e.g., infectious, toxic)

   Hepatic congestion due to heart disease