Endocrine Abstracts

Objective: To describe the clinical and biological presentation of acute pancreatitis (AP) and diabetic ketoacidosis (DKA) in type 1 diabetes (T1D).

Patients and Methods: A retrospective descriptive study of 10 T1DM patients with simultaneous DKA and AP.

Results: The mean age at diagnosis of T1DM was 19.7±9.3 years with a female predominance (60%). T1DM was frequently inaugurated by a cardinal syndrome (50%) or spontaneous DKA (20%). In 10%, T1DM was diagnosed at the time of AP. The mixed AP-DKA episode occurred at a mean age of 26.9±14.9 years. A febrile state (30%) with altered general condition (20%) and severe dehydration (10%) was often reported. Respiratory and neurological signs were present in 20%. Digestive signs were prominent, notably epigastralgia (90%), vomiting (50%), and diarrhea (20%). Acetonuria was massive in 50% with mean blood glucose levels of 3.2±1.4 g/l. Metabolic acidosis was noted in all cases with mean pH and bicarbonate values of 7±0.3 and 12.3±8.3 respectively. Functional renal failure complicated the course of 10% of cases. An infectious syndrome accompanied 40% of cases with a mean CRP of 47±72.9 mg/l. The evolution was favorable in all patients after appropriate treatment with an estimated insulin requirement of 0.76±0.3 IU/kg/d.

Discussion: The co-occurrence of DKA and AP in T1DM is a relatively rare but potentially serious event due to the mutually deleterious effects of these two conditions. The outcome of this mixed emergency depends on early diagnosis and prompt intervention.

References: 1. Zaher, Fatima Zahra, et al. "Diabetic ketoacidosis revealing a severe hypertriglyceridemia and acute pancreatitis in type 1 diabetes mellitus." Case Reports in Endocrinology 2019 (2019).

2. Nair, Satheesh, Dhiraj Yadav, and C. S. Pitchumoni. "Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA." The American journal of gastroenterology 95.10 (2000): 2795-2800.