Abstract

Background and Objectives: Diabetic ketoacidosis (DKA) is an acute, major, life threatening complication of diabetes characterised by hyperglycaemia, acidosis, ketonemia/ketonuria. DKA occurs mainly in patients with Type 1 diabetes and also to some extent in patients with Type 2 diabetes. There are case reports with non specific elevation of serum amylase and lipase in DKA patients without actual pancreatic involvement. As the symptoms like nausea, vomiting and abdominal pain can present in both DKA and acute pancreatitis, the elevation of serum amylase and lipase often leads to initial diagnosis of acute pancreatitis. But in the presence of DKA, the patients may need ultrasonogram and CECT abdomen to diagnose acute pancreatitis. So the present study was carried out to study the elevation of serum amylase and lipase levels in patients with DKA and its relevance to the presence of acute pancreatitis.

Materials and Methods: This cross-sectional study was conducted in the Emergency ward of Kanyakumari Government Medical College, Asaripallam during the study period of 6 months from November 2018 to April 2019. A total of 50 patients were included in the study after fulfilling the inclusion and exclusion criteria. A detailed clinical history including history for precipitating factors like omission of insulin and general physical and systemic examination and relevant investigations were done in patients included in the study.

Results: Among the 50 cases studied, 8 cases (16%) showed elevation in serum amylase levels and 11 cases (22%) had elevated serum lipase levels. USG abdomen and CECT abdomen were done in patients with elevated enzyme levels, but none of them showed any evidence of acute pancreatitis. This non-specific elevation of lipase was present in more number of cases (22%) than non-specific elevation of amylase (16%). So lipase levels elevation appears to be less specific than the amylase levels for the diagnosis of acute pancreatitis.

Conclusion: Elevated levels of serum amylase and lipase can occur in patients with DKA probably due to metabolic derangements and not due to acute pancreatitis.

Keywords: Diabetic ketoacidosis, amylase, lipase.