Korean J Gastroenterol.  2016 Nov;68(5):274-278. 10.4166/kjg.2016.68.5.274.

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

• Kim JH
• Oh MJ

• KMID: 2383506
• DOI: http://doi.org/10.4166/kjg.2016.68.5.274

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. Contrast-enhanced abdominal CT showed pancreatic swelling, peri-pancreatic 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.

Keyword

Pancreatitis; Diabetic ketoacidosis; Hypertriglyceridemia

MeSH Terms

Abdominal Pain
Acidosis
Adult
Ambulatory Care Facilities
Amylases
Back Pain
Diabetic Ketoacidosis*
Disseminated Intravascular Coagulation
Female
Fluid Therapy
Hospitalization
Humans
Hyperglycemia
Hypertriglyceridemia*
Hypocalcemia
Insulin
Ketosis
Lipase
Multiple Organ Failure
Pancreatitis*
Reference Values
Respiratory Distress Syndrome, Adult
Sensation
Tomography, X-Ray Computed
Triglycerides
Young Adult*
Amylases
Insulin
Lipase

Figure

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  Fig. 1. Contrastenhanced abdominal CT scans at admission showed a diffuse edematous change of the pancreas, peripancreatic fat infiltration, and peripancreatic fluid collection.

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  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.

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  Fig. 3. Changes in the patient's arterial pH and serum glucose levels. HD, hospital day.

Reference

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