Endocrine Abstracts

Introduction: Hypertriglyceridemia induced pancreatitis (HIP) is an uncommon condition accounting for 1–4% of cases of acute pancreatitis, mostly associated with poor glycemic control in diabetic patients. Diabetic ketoacidosis (DKA) may complicate the clinical course of HIP; however, few studies have documented this association. Our objective was to identify clinical and demographic differences between HIP patients with co-existing DKA compared to those without DKA.

Methods: Seven consecutive patients with DKA and HIP were compared with 7 age and gender paired HIP controls. We analyzed risk factors for the development of DKA, compared severity of illness, hospital length of stay, diet indications, duration of insulin treatment, and biochemical markers of pancreatitis. Statistical significance was considered if P<0.05.

Results: DKA was associated with more severe HIP compared to non-DKA patients, with Ranson’s prognostic criteria 4±2 vs 1±1 (P=0.009) and APACHE II 9±3 vs 4±2 (P=0.004). There were no differences in previous diagnosis of diabetes mellitus (85 vs 71%, P=1.0), length of stay (8±3 vs 7±2 days, P=0.24), fasting duration (4±2 vs 4±1 days, P=0.47), or duration of treatment with insulin infusion (6±4 vs 3±1 days, P=0.12). Serum amylase, leukocyte levels and triglycerides did not differ in both groups (P=0.96, 0.94 and 0.80). Insulin dose during infusion treatment (0.09±0.04 vs 0.04±0.02 U/kg per hour, P=0.012) and discharge insulin dose (74±32 vs 33±23 U, P=0.02) were higher in DKA compared to non-DKA patients.

Conclusion: There were no statistical risk factors associated with the development of DKA in HIP. Even though DKA is associated with more severe HIP, no differences were observed in: length of stay, fasting duration, insulin infusion time, biochemical markers. As expected, DKA is associated with higher insulin dose during insulin infusion time as well as at discharge.