Journal List > Korean J Gastroenterol > v.68(5) > 1007581

Kim and Oh: Acute Pancreatitis Complicated with Diabetic Ketoacidosis in a Young Adult without Hypertriglyceridemia: A Case Report

Abstract

Systemic complications related to acute pancreatitis include acute respiratory distress syndrome, multiple organ dysfunction syndrome, disseminated intravascular coagulation, hypocalcemia, hyperglycemia, and insulin dependent diabetes or diabetic ketoacidosis. In practice, the development of diabetic ketoacidosis induced by acute pancreatitis is rare and generally associated with hypertriglyceridemia. However, herein we report a case of a 34-year-old female without hypertriglyceridemia, who was diagnosed with acute pancreatitis complicated with diabetic ketoacidosis. The patient was admitted with complaints of febrile sensation, back pain, and abdominal pain around the epigastric area. Levels of serum amylase and lipase were elevated to 663 U/L and 3,232 U/L. Contrastenhanced abdominal CT showed pancreatic swelling, peripancreatic fat infiltration and fluid collection. The patient was initially diagnosed with simple acute pancreatitis. Though the symptoms were rapidly relieved after initiation of treatment, severe hyperglycemia (575 mg/dL), severe metabolic acidosis (pH 6.9), and ketonuria developed at four days after hospitalization. However, serum triglyceride levels remained within the normal range (134 mg/dL). Finally, the patient was diagnosed with acute pancreatitis complicated with diabetic ketoacidosis unrelated to hypertriglyceridemia. She recovered through insulin and fluid therapy, and receives insulin therapy at the outpatient clinic.

References

1. Steinberg W, Tenner S. Acute pancreatitis. N Engl J Med. 1994; 330:1198–1210.
crossref
2. Browne GW, Pitchumoni CS. Pathophysiology of pulmonary complications of acute pancreatitis. World J Gastroenterol. 2006; 12:7087–7096.
crossref
3. Aboulhosn K, Arnason T. Acute pancreatitis and severe hyper-triglyceridaemia masking unsuspected underlying diabetic ketoacidosis. BMJ Case Rep. 2013. DOI: doi:10.1136/bcr-2013–200431.
crossref
4. Quintanilla-Flores DL, Rendón-Ramírez EJ, Colunga-Pedraza PR, Gallardo-Escamilla J, Corral-Benavides SA, González-González JG, et al. Clinical course of diabetic ketoacidosis in hyper-triglyceridemic pancreatitis. Pancreas. 2015; 44:615–618.
crossref
5. Shenoy SD, Cody D, Rickett AB, Swift PG. Acute pancreatitis and its association with diabetes mellitus in children. J Pediatr Endocrinol Metab. 2004; 17:1667–1670.
crossref
6. Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974; 139:69–81.
7. Johnson CD, Toh SK, Campbell MJ. Combination of APACHE-II score and an obesity score (APACHE-O) for the prediction of severe acute pancreatitis. Pancreatology. 2004; 4:1–6.
crossref
8. Balthazar EJ. CT diagnosis and staging of acute pancreatitis. Radiol Clin North Am. 1989; 27:19–37.
9. Lankisch PG, Apte M, Banks PA. Acute pancreatitis. Lancet. 2015; 386:85–96.
crossref
10. Johnson CD, Besselink MG, Carter R. Acute pancreatitis. BMJ. 2014; 349:g4859.
crossref
11. Singla AA, Ting F, Singla A. Acute pancreatitis secondary to diabetic ketoacidosis induced hypertriglyceridemia in a young adult with undiagnosed type 2 diabetes. JOP. 2015; 16:201–204.
12. Nair S, Yadav D, Pitchumoni CS. Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA. Am J Gastroenterol. 2000; 95:2795–2800.
crossref
13. Nair S, Pitchumoni CS. Diabetic ketoacidosis, hyperlipidemia, and acute pancreatitis: the enigmatic triangle. Am J Gastroenterol. 1997; 92:1560–1561.
14. Winter RJ, Herr TJ, Stone NJ, Traisman HS. Diabetic lipemia in childhood diabetic ketoacidosis: a clue to coexisting acute pancreatitis. Diabetes Care. 1980; 3:706–767.
crossref
15. Hahn SJ, Park JH, Lee JH, Lee JK, Kim KA. Severe hypertriglyceridemia in diabetic ketoacidosis accompanied by acute pancreatitis: case report. J Korean Med Sci. 2010; 25:1375–1378.
crossref

Fig. 1.
Contrastenhanced abdominal CT scans at admission showed a diffuse edematous change of the pancreas, peripancreatic fat infiltration, and peripancreatic fluid collection.
kjg-68-274f1.tif
Fig. 2.
Contrastenhanced abdominal CT scans at the time of diagnosis of diabetic ketoacidosis revealed slightly swelling of the pancreas, and no evidence of necrosis and newly developed complications.
kjg-68-274f2.tif
Fig. 3.
Changes in the patient's arterial pH and serum glucose levels. HD, hospital day.
kjg-68-274f3.tif
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