Clinical and Laboratory Observation
Pancreatic enzyme elevations in children with diabetic ketoacidosis

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Abstract

The incidence of pancreatic enzyme elevations in children with diabetic ketoacidosis (DKA) compared with children with newly diagnosed diabetes without DKA was assessed in a prospective study.

Pancreatic enzyme elevations, particularly hyperlipasemia, are common but not associated with significant symptomatology. Acute pancreatitis was diagnosed in 2% of children with DKA.

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Methods

After approval by the institutional review committee, children hospitalized for DKA between December 2001 and February 2003 were enrolled. Patients newly diagnosed with diabetes but not in DKA served as controls. Informed consent was obtained for all subjects. Subjects with a history of pancreatitis, gallstones, hypertriglyceridemia, or intake of medications associated with pancreatitis were excluded. The diagnosis of DKA was established by hyperglycemia, ketosis, and acidosis (bicarbonate < 15

Results

Fifty children with DKA and 12 children with newly diagnosed diabetes without DKA were enrolled. All patients had type I diabetes (Table 1).

Twenty-one patients with DKA (40%) had an elevated amylase and/or lipase.

Lipase was increased in 20 patients (38%), whereas amylase was elevated in 10 (19%). Seven patients (13%) had an elevated lipase greater than 3 times normal, whereas 2 (4%) had a significantly elevated amylase. Nine of 10 patients with amylase elevation also had an increased lipase,

Discussion

Our data indicate that pancreatic enzyme elevations, particularly hyperlipasemia, are very common in children with DKA. The magnitude of lipase elevation appears to correlate with the degree of acidosis, whereas hyperamylasemia is nonspecific. The majority of patients with elevated enzymes had no significant abdominal symptoms or delay in their clinical recovery. In those with persistent abdominal symptoms after acidosis resolved, abdominal CT findings were normal. Acute pancreatitis was

Acknowledgements

We acknowledge Dr Linda Dimeglio for her careful revision of the manuscript and valuable input.

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Supported in part by a grant from the Biomedical Research Committee at Indiana University School of Medicine for the use of laboratory core facilities.

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