Nonspecific hyperamylasemia and hyperlipasemia in diabetic ketoacidosis: incidence and correlation with biochemical abnormalities

Abstract

In DKA nonspecific elevations of amylase and lipase occur in 16-25% of cases. Amylase elevation is correlated with pH and serum osmolality, but lipase elevation is correlated with serum osmolality alone. Diagnosis of AP based soley on elevated amylase or lipase, even > 3 times normal, is not justifiable.

Elevated serum amylase and lipase in pediatric diabetic ketoacidosis*

“…Only one of these children was found to have acute pancreatitis. In a separate study of 135 adults with 150 episodes of DKA, 24.6% of episodes involved elevated amylase and 36.3% of episodes involved elevated lipase; however, among these adult patients, 32% and 26.5% of the episodes with enzyme elevation had radiographic evidence of acute pancreatic injury, respectively (19).…”

Origin, Presentation, and Clinical Course of Nonpancreatic Hyperlipasemia

“…6,25,26 Likewise, those with diabetes or diabetic ketoacidosis often have relative renal hypoperfusion resulting in an elevated baseline serum lipase level from reduced lipase clearance. 27 In those with diabetes type 2, 13% to 20.4% of patients have serum lipase levels greater than 1 time ULN, and 1% to 2.1% of patients may have lipase levels greater than 3 times the ULN. 28,29 Yadav et al 27 demonstrated that, in patients with diabetic ketoacidosis, elevated lipase levels greater than 3 times the ULN can be seen in as many as 8.7% of patients despite computed tomography imaging confirming a normal pancreas.…”

Severe Hypertriglyceridemia in Diabetic Ketoacidosis Accompanied by Acute Pancreatitis: Case Report

“…The mechanism is believed to be the interference with in vitro determination of the actual amylase level by disturbance of the calorimetric method. Serial dilutions of the sample could reduce interference of light transmission by hyperlipidemic serum (17). In the present case, increased amylase occurred parallel to the decreased TG level, which might have delayed the diagnosis of acute pancreatitis at initial presentation.…”

“…Even worse, nonspecific elevations of amylase and/or lipase without clinical evidence of pancreatitis have been reported in 24.7-79.0% of DKA cases (17). At least in those patients with continuous abdominal pain, it is prudent to seek further laboratory evaluation or a CT scan of the abdomen.…”