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
2. Browne GW, Pitchumoni CS. Pathophysiology of pulmonary complications of acute pancreatitis. World J Gastroenterol. 2006; 12:7087–7096.
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.
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.
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.
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.
8. Balthazar EJ. CT diagnosis and staging of acute pancreatitis. Radiol Clin North Am. 1989; 27:19–37.
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.
13. Nair S, Pitchumoni CS. Diabetic ketoacidosis, hyperlipidemia, and acute pancreatitis: the enigmatic triangle. Am J Gastroenterol. 1997; 92:1560–1561.