Mysore Medical College and Research Institute, Mysore.
J Assoc Physicians India. 2022 Apr;70(4):11-12.
Diabetic ketoacidosis is one of the hyperglycemic emergencies, there is insulin deficiency coupled with concomitant elevation of counter regulatory hormones. This hormonal imbalance promotes gluconeogenesis, glycolysis, glycogenolysis, protein breakdown and lipolysis.The symptoms of DKA like nausea, vomiting, epigastric pain can be present in acute pancreatitis also. From various studies it has been identified that in DKA, non specific elevation of serum amylase and lipase levels occurs in 16-25% of cases. Elevation of serum amylase, and lipase levels in association with severe abdominal pain often trigger the initial diagnosis of acute pancreatitis. So this study was carried out to study the elevation of serum amylase and lipase levels in patients with DKA.
This cross sectional study was conducted in department of medicine KR Hospital,Mysore medical college and research institute, mysore during the study period of six months from June 2021 to november 2021. A total of 50 patients were included in the study after fulfilling the inclusion and exclusion criteria.
Among 50 cases studied, 9 cases (18%) with DKA are showing elevation of serum amylase levels and 13 cases(26%) of cases are showing elevation of serum lipase,34 cases(68%) were males and 16 cases(32%) were female. Among the 50 cases studied,infection is the most precipitating factor seen in 34cases (68%),followed by omission of insulin in 12 cases(24%), unidentified cause in 4 cases(8%).
significant elevation of serum amylase and serum lipase which are more specific for diagnosis of acute pancreatitis can also be seen in patients with diabetic ketoacidosis. Elevated serum amylase and lipase can occur in patients with DKA probably due to metabolic derangements,decreased clearance of enzymes and not due to acute pancreatitis The clinician must take these data into account when evaluating abdominal symptoms in DKA patients.
糖尿病酮症酸中毒是高血糖急症之一，存在胰岛素缺乏，同时伴随拮抗激素的升高。这种激素失衡促进糖异生、糖酵解、糖原分解、蛋白质分解和脂肪分解。糖尿病酮症酸中毒的症状如恶心、呕吐、上腹痛也可能存在于急性胰腺炎中。从各种研究中已经确定，在糖尿病酮症酸中毒中，16-25%的病例会出现血清淀粉酶和脂肪酶水平的非特异性升高。血清淀粉酶和脂肪酶水平升高并伴有严重腹痛常引发急性胰腺炎的初始诊断。因此，进行了这项研究，以研究糖尿病酮症酸中毒患者血清淀粉酶和脂肪酶水平的升高。
这项横断面研究在迈索尔医学科学研究所 KR 医院内科进行，研究期间为 2021 年 6 月至 2021 年 11 月，共纳入 50 例符合纳入和排除标准的患者。
在研究的 50 例病例中，有 9 例（18%）糖尿病酮症酸中毒患者的血清淀粉酶水平升高，有 13 例（26%）患者的血清脂肪酶水平升高，34 例（68%）为男性，16 例（32%）为女性。在研究的 50 例病例中，感染是最常见的诱发因素，见于 34 例（68%），其次是胰岛素遗漏，见于 12 例（24%），原因不明，见于 4 例（8%）。
血清淀粉酶和血清脂肪酶的显著升高，这些酶对急性胰腺炎的诊断更具特异性，也可见于糖尿病酮症酸中毒患者。糖尿病酮症酸中毒患者的血清淀粉酶和脂肪酶升高可能是由于代谢紊乱、酶清除减少所致，而不是由于急性胰腺炎。临床医生在评估糖尿病酮症酸中毒患者的腹部症状时，必须考虑到这些数据。
