Clinical Course of Diabetic Ketoacidosis in Hypertriglyceridemic Pancreatitis

Quintanilla-Flores, Dania Lizet; Rendón-Ramírez, Erick Joel; Colunga-Pedraza, Perla R.; Gallardo-Escamilla, Jesús; Corral-Benavides, Sergio Antonio; González-González, José Gerardo; Tamez-Pérez, Héctor Eloy

doi:10.1097/mpa.0000000000000300

Cited by 12 publications

(8 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Additionally, DKA raised the Ranson and APACHE II scores of AP patients, 19 which demonstrated that the DKA group had higher levels of random glucose, AG, BUN, LDH, ALT, and TBIL, but lower levels of Ca 2þ and CO 2 CP on admission. Patients with concurrent DKA had more severe organ dysfunction and acid-base disturbance, which were in accordance with the data from Quintanilla-Flores et al 20 Additionally, the existence of AP aggravated the severity of DKA due to marked acidosis, hyperglycemia, and increased depletion of intravascular volume. 6 Simons-Linares et al 7 recently performed the largest cohort study to date on the coexistence of AP and DKA, in which 2.8 million patients were hospitalized with AP and 33,356 had concomitant DKA.…”

Section: Discussionsupporting

confidence: 90%

Acute pancreatitis concomitant with diabetic ketoacidosis: a cohort from South China

et al. 2020

View full text Add to dashboard Cite

Objective: To evaluate the clinical characteristics of acute pancreatitis (AP) concomitant with diabetic ketoacidosis (DKA) in a cohort from South China and identify factors associated with early detection of DKA in AP patients. Methods: Inpatient medical records of AP concomitant with DKA were retrospectively reviewed. Results: Forty-eight patients with AP concomitant with DKA were enrolled in this study. The results indicated that comorbidity history of diabetes mellitus and mental status of not alert on admission were factors associated with DKA in AP patients. Compared with patients without DKA, patients with DKA showed significantly higher rates of hypertriglyceridemia and lower rates of gallstones than those without DKA. AP patients with concurrent DKA had higher levels of serum triglycerides, longer lengths of hospital stays, and higher complication rates of systemic inflammatory response syndrome and acute kidney injury. Conclusion: AP patients might have higher risks of concomitant DKA if presenting as not alert upon admission or if they have past medical histories of diabetes mellitus. Serum triglyceride levels were significantly higher in AP patients with DKA. DKA raised the severity of AP, but did not increase in-hospital mortality.

show abstract

Section: Discussionsupporting

confidence: 90%

Acute pancreatitis concomitant with diabetic ketoacidosis: a cohort from South China

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The later study did not find higher mortality in the 8 DKA patients but did find more severe AP based on Ranson criteria and APACHE II scores. [4] Although these AP severity-scoring systems are confounded by elevated glucose, base deficit and low pH that are directly influenced by DKA and not by AP and should not be used to assess AP severity and new AP severity scoring systems need to be developed for application in DKA with AP patients. [5]…”

Section: Discussionmentioning

confidence: 99%

The triad of diabetes ketoacidosis, hypertriglyceridemia and acute pancreatitis. How does it affect mortality and morbidity?

Simons-Linares¹,

Jang²,

Sanaka³

et al. 2019

Medicine

View full text Add to dashboard Cite

The triad of acute pancreatitis (AP) coexisting with diabetes ketoacidosis (DKA) and hypertriglyceridemia (HTG) has been reported, but no impact on mortality has been found to date. We aim to assess if patients with this triad are at a higher inpatient mortality compared to patients with acute pancreatitis only. Retrospective cohort. The National Inpatient Sample (NIS) database from 2003 to 2013 was queried for patients with a discharge diagnosis of AP and presence of DKA and HTG was ascertained based on International Classification of Diseases, 9th revision (ICD9) codes. Adjusted for age, gender, race, Charlson comorbidity index (CCI), median income quartile, and hospital characteristics. Over 2.8 million AP patients were analyzed. When compared with patients with AP-only, patients with the triad of AP + DKA + HTG had higher inpatient mortality (aOR 2.8, P < .001; CI: 1.9 - 4.2), Acute Kidney Injury (AKI) (aOR 4.1, P < .001; CI: 3.6-4.6), Systemic Inflammatory Response Syndrome (SIRS) (aOR 4.9, P < .001), Shock (aOR 4.3, P < .001), Acute Respiratory Distress Syndrome (ARDS) (aOR 3.0, P < .001), sepsis (aOR 2.6, P < .001), ileus (aOR 2.1, P < .001), parenteral nutrition requirement (aOR 1.8, P < .001), inflation-adjusted hospital charges (US$ 17,704.1), and had longer length of stay (LOS) (aOR 2.0, P < .001; CI 1.8–2.3). Furthermore, when compared to AP-only, patients with AP + HTG had lower mortality, which is different from the current AP knowledge. Finally, it appears that the driving force for the increased in mortality of patients with the triad (AP, DKA, HTG) is the DKA rather than the HTG. Patients with the triad of AP, DKA, and HTG constitute a unique subgroup of patients that has higher inpatient mortality, multi-organ failure, hospital charges, and longer hospital length of stay. Therefore, hospital protocols targeting this subgroup of AP patients could improve mortality and outcomes.

show abstract

“…This was concluded in a recently published systematic review of 38 studies on hyperlipidemic pancreatitis [ 6 ]. One study also reported observations of more severe episodes of HTGAP with co-existing DKA [ 7 ]. Nielson et al estimated a mortality rate of 80% in patients with AP and co-existing DKA [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Diabetic Ketoacidosis and the Domino Effect

et al. 2018

View full text Add to dashboard Cite

Patient: Male, 27Final Diagnosis: Hypertriglyceridemia associated acute pancreatitis secondary to diabetic ketoacidosisSymptoms: Abdominal painMedication: —Clinical Procedure: —Specialty: Endocrinology and MetabolismObjective:Rare diseaseBackground:Severe hypertriglyceridemia is a well-known cause of acute pancreatitis. Mild elevations of triglyceride levels are common in patients presenting with diabetic ketoacidosis (DKA). Rarely, DKA can be accompanied by an elevation of serum triglyceride level severe enough to lead to AP.Case Report:We report one such case of a young diabetic male who presented with DKA that was complicated by hypertriglyceridemia-induced acute pancreatitis (HTGAP). We were able to treat the condition with a slightly prolonged infusion of intravenous (IV) regular insulin in an efficient and cost-effective manner with a good outcome.Conclusions:From our experience, DKA-associated HTGAP can be rapidly, efficiently, and cost-effectively treated with IV regular insulin and close biochemical monitoring. A high index of suspicion for acute pancreatitis is necessary in patients with DKA, especially with co-existing hypertriglyceridemia; and all efforts should be made to diagnose it in a timely manner to prevent subsequent complications.

show abstract

Clinical Course of Diabetic Ketoacidosis in Hypertriglyceridemic Pancreatitis

Cited by 12 publications

References 15 publications

Acute pancreatitis concomitant with diabetic ketoacidosis: a cohort from South China

Acute pancreatitis concomitant with diabetic ketoacidosis: a cohort from South China

The triad of diabetes ketoacidosis, hypertriglyceridemia and acute pancreatitis. How does it affect mortality and morbidity?

Diabetic Ketoacidosis and the Domino Effect

Contact Info

Product

Resources

About