Elevated amylase and lipase levels in patients with DKA followed in the pediatric intensive care unit
-
Gulhan Atakul
,
Meliha Demiral
and
Güliz Gürer
Abstract
Objectives
Diabetic ketoacidosis (DKA) is a life-threatening acute metabolic decompensation condition due to insulin deficiency and elevation of pancreatic enzymes is common. The goal of this study was to determine the laboratory findings and biochemical characteristics associated with pancreatic enzyme elevation during DKA.
Methods
The files of patients hospitalized in the pediatric intensive care unit with the diagnosis of DKA between March 2020 and 2022 were reviewed retrospectively. Demographic data, length of stay at hospital, initial biochemistry, hemogram, blood gas values, amylase, and lipase in the first 24 h were noted. Those with elevated amylase and/or lipase values were grouped. Patients were grouped according to the severity of DKA. These groups were analyzed statistically.
Results
Amylase and/or lipase were found to be elevated in 21 (28%) of diagnosed with DKA. pH and HCO3 were significantly lower, length of stay in the intensive care unit, and triglyceride levels were significantly higher in patients with high amylase and/or lipase when compared with the control group (p<0.05). Although lipase values have a negative correlation with blood gas parameters and a positive correlation with TG and cholesterol values, correlation degree was found to be weak (p<0.05). Lipase was significantly higher in the severe diabetic ketoacidosis group than the moderate group (p<0.001).
Conclusions
Elevations in amylase and lipase values can be encountered frequently in patients with DKA. Considering that the metabolic deterioration due to DKA may have an effect on this, we recommend that the patient should be followed closely and the enzyme level should be monitored intermittently.
-
Research funding: There is no source of financial assistance.
-
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
-
Competing interests: Authors state no conflict of interest.
-
Informed consent: Informed consent was obtained from all individuals included in this study.
-
Ethical approval: Our study was approved by Medipol University Ethics Committee.
References
1. Dabelea, D, Rewers, A, Stafford, JM, Standiford, DA, Lawrence, JM, Saydah, S, et al.. Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study. Pediatrics 2014;133:e938–45. https://doi.org/10.1542/peds.2013-2795.Search in Google Scholar PubMed PubMed Central
2. Zucchini, S, Scaramuzza, AE, Bonfanti, R, Buono, P, Cardella, F, Cauvin, V, et al.. A multicenter retrospective survey regarding diabetic ketoacidosis management in Italian children with type 1 diabetes. J Diabetes Res 2016;2016:5719470. https://doi.org/10.1155/2016/5719470.Search in Google Scholar PubMed PubMed Central
3. Demiral, M, Binay, Ç, Şimşek, E. Epidemiological characteristics of patients followed up with the diagnosis of type 1 diabetes mellitus in Eskişehir province. J Child Health Dis 2016;59:14–20.Search in Google Scholar
4. Glaser, NS, Wootton-Gorges, SL, Marcin, JP, Buonocore, MH, Dicarlo, J, Neely, EK, et al.. Mechanism of cerebral edema in children with diabetic ketoacidosis. J Pediatr 2004;145:164–71. https://doi.org/10.1016/j.jpeds.2004.03.045.Search in Google Scholar PubMed
5. Chan-Cua, S, Jones, KL, Lynch, FP, Freidenberg, GR. Necrosis of the ileum in a diabetic adolescent. J Pediatr Surg 1992;27:1236–8. https://doi.org/10.1016/0022-3468(92)90798-c.Search in Google Scholar PubMed
6. Wolfsdorf, JI, Glaser, N, Agus, M, Fritsch, M, Hanas, R, Rewers, A, et al.. ISPAD Clinical Practice Consensus Guidelines 2018: diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes 2018;19:155. https://doi.org/10.1111/pedi.12701.Search in Google Scholar PubMed
7. Haddad, NG, Croffie, JM, Eugster, EA. Pancreatic enzyme elevations in children with diabetic ketoacidosis. J Pediatr 2004;145:122.10.1016/j.jpeds.2004.03.050Search in Google Scholar PubMed
8. Quiros, JA, Marcin, JP, Kuppermann, N, Nasrollahzadeh, F, Rewers, A, DiCarlo, J, et al.. Elevated serum amylase and lipase in pediatric diabetic ketoacidosis. Pediatr Crit Care Med 2008;9:418.10.1097/PCC.0b013e318172e99bSearch in Google Scholar PubMed
9. Warshaw, AL, O’Hara, PJ. Susceptibility of the pancreas to ischemic injury in shock. Ann Surg 1978;188:197–201. https://doi.org/10.1097/00000658-197808000-00012.Search in Google Scholar PubMed PubMed Central
10. Yadav, D, Nair, S, Norkus, EP, Pitchumoni, CS. Nonspecific hyperamylasemia and hyperlipasemia in diabetic ketoacidosis: incidence and correlation with biochemical abnormalities. Am J Gastroenterol 2000;95:3123–8. https://doi.org/10.1111/j.1572-0241.2000.03279.x.Search in Google Scholar PubMed
11. Yanai, H. Diagnosis of secondary hyperlipidemia due to diabetes. Rinsho Byori 2016;64:508–12.Search in Google Scholar
12. Hirano, T. Pathophysiology of diabetic dyslipidemia. J Atherosclerosis Thromb 2018;25:771–82. https://doi.org/10.5551/jat.rv17023.Search in Google Scholar PubMed PubMed Central
13. Weidman, SW, Ragland, JB, Fisher, JNJr, Kitabchi, AE, Sabesin, SM. Effects of insulin on plasma lipoproteins in diabetic ketoacidosis: evidence for a change in high density lipoprotein composition during treatment. J Lipid Res 1982;23:171–82. https://doi.org/10.1016/s0022-2275(20)38186-4.Search in Google Scholar
14. Fortson, MR, Freedman, SN, Webster, PD3rd. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol 1995; 90:2134.Search in Google Scholar
15. Nair, S, Yadav, D, Pitchumoni, CS. Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA. Am J Gastroenterol 2000;95:2795.10.1111/j.1572-0241.2000.03188.xSearch in Google Scholar PubMed
16. Liu, J, Yan, H, Li, Y. Hyperlactatemia associated with diabetic ketoacidosis in pediatric intensive care unit. BMC Endocr Disord 2021;21:110. https://doi.org/10.1186/s12902-021-00776-9.Search in Google Scholar PubMed PubMed Central
17. Ludvigsson, J. No acute pancreatitis but reduced exocrine pancreatic function at diagnosis of type 1 diabetes in children. Pediatr Diabetes 2019;20:915–9. https://doi.org/10.1111/pedi.12904.Search in Google Scholar PubMed
18. Chandra, D, Bsavaraju, M, Mr, R, Av, A, Sandhya, R. Serum amylase and lipase estimation in diabetic ketoacidosis. J Assoc Phys India 2022;70:11–12.Search in Google Scholar
© 2022 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Review
- One half-century of advances in the evaluation and management of disorders of bone and mineral metabolism in children and adolescents
- Original Articles
- Safety and user experience with off-label use of a flash glucose monitor (FreeStyle Libre® 1) among very young children with type 1 diabetes mellitus
- Sonic hedgehog N-terminal level correlates with adiponectin level and insulin resistance in adolescents
- Elevated amylase and lipase levels in patients with DKA followed in the pediatric intensive care unit
- The relationship between alexithymia, health literacy, and diet quality in obese adolescents
- The role of the deficiency of vitamin B12 and folic acid on homocysteinemia in children with Turner syndrome
- Clinical spectrum and diagnostic challenges of vitamin D dependent rickets type 1A (VDDR1A) caused by CYP27B1 mutation in resource limited countries
- Comparative characteristics of developing morphofunctional features of schoolchildren from different climatic and geographical regions
- Leucine tolerance in children with MSUD is not correlated with plasma leucine levels at diagnosis
- Outcomes of children with severe diabetic ketoacidosis managed outside of a pediatric intensive care unit
- Thiamine status during treatment of diabetic ketoacidosis in children – tertiary care centre experience
- Premature adrenarche in Prader–Willi syndrome is associated with accelerated pre-pubertal growth and advanced bone age
- Short Communication
- Diagnosis of adrenal insufficiency in children: a survey among pediatric endocrinologists in North America
- Case Reports
- Pediatric growth hormone and prolactin-secreting tumor associated with an AIP mutation and a MEN1 variant of uncertain significance
- Two cases of MEGDHEL syndrome diagnosed with hyperammonemia
- Hyperinsulinism–hyperammonemia syndrome in two Peruvian children with refractory epilepsy
- A case report of a young boy with low renin and high aldosterone levels induced by Liddle syndrome who was previously misdiagnosed with primary aldosteronism
- Adolescents with type 1 diabetes vs. hybrid closed loop systems: a case series of patients’ behaviour that challenges the algorithm.
Articles in the same Issue
- Frontmatter
- Review
- One half-century of advances in the evaluation and management of disorders of bone and mineral metabolism in children and adolescents
- Original Articles
- Safety and user experience with off-label use of a flash glucose monitor (FreeStyle Libre® 1) among very young children with type 1 diabetes mellitus
- Sonic hedgehog N-terminal level correlates with adiponectin level and insulin resistance in adolescents
- Elevated amylase and lipase levels in patients with DKA followed in the pediatric intensive care unit
- The relationship between alexithymia, health literacy, and diet quality in obese adolescents
- The role of the deficiency of vitamin B12 and folic acid on homocysteinemia in children with Turner syndrome
- Clinical spectrum and diagnostic challenges of vitamin D dependent rickets type 1A (VDDR1A) caused by CYP27B1 mutation in resource limited countries
- Comparative characteristics of developing morphofunctional features of schoolchildren from different climatic and geographical regions
- Leucine tolerance in children with MSUD is not correlated with plasma leucine levels at diagnosis
- Outcomes of children with severe diabetic ketoacidosis managed outside of a pediatric intensive care unit
- Thiamine status during treatment of diabetic ketoacidosis in children – tertiary care centre experience
- Premature adrenarche in Prader–Willi syndrome is associated with accelerated pre-pubertal growth and advanced bone age
- Short Communication
- Diagnosis of adrenal insufficiency in children: a survey among pediatric endocrinologists in North America
- Case Reports
- Pediatric growth hormone and prolactin-secreting tumor associated with an AIP mutation and a MEN1 variant of uncertain significance
- Two cases of MEGDHEL syndrome diagnosed with hyperammonemia
- Hyperinsulinism–hyperammonemia syndrome in two Peruvian children with refractory epilepsy
- A case report of a young boy with low renin and high aldosterone levels induced by Liddle syndrome who was previously misdiagnosed with primary aldosteronism
- Adolescents with type 1 diabetes vs. hybrid closed loop systems: a case series of patients’ behaviour that challenges the algorithm.
