Severe Acute Necrotizing Pancreatitis in a Patient with Diabetic Ketoacidosis

Abstract

A 43-year-old uninsured man with a history of heavy alcohol abuse was admitted to the hospital with 6 months of malaise, nausea, abdominal distension, and pain. More recently he was experiencing dizziness, weakness, excessive urinary volume, and a nonproductive cough. Approximately four months before presentation he had been diagnosed with diabetes mellitus, but was unable to comply with recommended medications because of the cost. ASSESSMENT The patient was tachycardic, with a pulse of 132 beats per minute. His other vital signs were unremarkable. Physical examination was notable for dry mucous membranes, Kussmaul breathing, distension of the abdomen with a palpable liver edge, caput medusa stigmata, and bilateral trace lower extremity edema. Laboratory investigations revealed blood glucose of 457 mg/dL, hemoglobin A1c of 9.8%, arterial pH of 7.314, serum bicarbonate of 7.5 mEq/L, positive urine ketones, and an anion gap of 29 mmol/L. b-Hydroxybutyrate was elevated to Funding: None.