Zaffar Duha, Rawat Aditi, Chow Robert T, Munir Kashif M
Department of Internal Medicine, University of Maryland Medical Centre Midtown Campus, Baltimore, Maryland.
Student of Medicine, American University of Antigua College of Medicine, Antigua.
AACE Clin Case Rep. 2024 Jul 29;10(6):220-223. doi: 10.1016/j.aace.2024.07.007. eCollection 2024 Nov-Dec.
BACKGROUND/OBJECTIVE: Diabetic ketoacidosis (DKA) is typically but not exclusively seen in patients with a history of diabetes mellitus.
This is a case of 39 year-old male who was diagnosed with acute pancreatitis based on characteristic symptoms and positive CT findings on presentation. Laboratory testing revealed elevated serum glucose 251 mg/dL, low serum bicarbonate 8 mmol/L, increased anion gap 21, and elevated serum beta-hydroxybutyrate 9.62 mmol/L. Diagnosis of DKA was made, however patient did not carry a diagnosis of diabetes mellitus. His hemoglobin A1c in hospital was normal at 5.4%. Additionally, follow-up hemoglobin A1c at 4 months and 10 months postdischarge did not imply diabetes mellitus, 5.8% at both time points. The patient who was initially managed with intravenous insulin required no insulin or oral diabetic medication on discharge. All these findings argued against new onset diabetes mellitus.
This case explores the potential pathophysiology that underlies this phenomenon including possible transient insulin insufficiency due to beta cell dysfunction from pancreatic inflammation. It also highlights the reversibility and transiency of possible beta cell dysfunction during acute pancreatitis and emphasizes the importance of closely assessing the patients' insulin requirements upon discharge, especially when a prior history of diabetes mellitus is absent.
DKA can occur as a rare complication of acute pancreatitis in a nondiabetic patient. Hyperglycemia associated with acute pancreatitis-induced DKA can be temporary and these patients might not necessarily require insulin upon discharge. Therefore, careful discharge planning is very important in such patients.
背景/目的：糖尿病酮症酸中毒（DKA）通常但并非仅见于有糖尿病病史的患者。
这是一例39岁男性患者，根据其特征性症状及就诊时CT检查结果阳性被诊断为急性胰腺炎。实验室检查显示血清葡萄糖升高至251mg/dL，血清碳酸氢盐降低至8mmol/L，阴离子间隙增加至21，血清β-羟基丁酸升高至9.62mmol/L。虽诊断为DKA，但该患者并无糖尿病病史。其住院时糖化血红蛋白A1c正常，为5.4%。此外，出院后4个月和10个月的糖化血红蛋白A1c随访结果也未提示糖尿病，两个时间点均为5.8%。该患者最初接受静脉胰岛素治疗，出院时无需胰岛素或口服降糖药物。所有这些发现均不支持新发糖尿病的诊断。
本病例探讨了这一现象潜在的病理生理学机制，包括胰腺炎症导致β细胞功能障碍可能引起的短暂胰岛素不足。它还强调了急性胰腺炎期间可能存在的β细胞功能障碍的可逆性和短暂性，并强调了出院时密切评估患者胰岛素需求的重要性，尤其是在无糖尿病病史的情况下。
DKA可作为非糖尿病患者急性胰腺炎的罕见并发症出现。急性胰腺炎诱发DKA相关的高血糖可能是暂时的，这些患者出院时不一定需要胰岛素治疗。因此，对此类患者进行仔细的出院计划非常重要。
