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Elevated serum amylase and lipase in pediatric diabetic ketoacidosis

J Antonio Quiros1, James P Marcin, Nathan Kuppermann

  • 1Division of Gastroenterology, University of California Davis School of Medicine and the UC Davis Children's Hospital, USA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|May 23, 2008
PubMed

Insights

Pancreatic enzyme elevations are common in children with diabetic ketoacidosis (DKA) but rarely indicate pancreatitis. These elevations correlate with higher blood urea nitrogen levels, not abdominal pain.

Area of Science:

  • Pediatric Endocrinology
  • Gastroenterology
  • Biochemistry

Background:

  • Pancreatic enzyme concentrations are often elevated in pediatric patients experiencing diabetic ketoacidosis (DKA).
  • The clinical and biochemical factors linked to these elevations require further investigation.

Purpose of the Study:

  • To identify clinical and biochemical characteristics associated with elevated pancreatic enzyme levels in children with DKA.
  • To test the hypothesis that pancreatic enzyme elevations correlate with biochemical markers of hypoperfusion.

Main Methods:

  • A prospective cohort study was conducted across three university-affiliated children's hospitals.
  • Data were collected from 67 children under 18 years old hospitalized with DKA.
  • Serum electrolyte, lactate, calcium, phosphate, magnesium, amylase, lipase, and triglyceride levels were monitored at various intervals during the initial 48 hours of DKA treatment.

Main Results:

  • Elevated lipase was observed in 31% and elevated amylase in 24% of pediatric DKA patients.
  • Pancreatic enzyme levels peaked between 12-24 hours after DKA treatment initiation.
  • Elevated blood urea nitrogen (BUN) was associated with increased amylase and lipase levels. Hypophosphatemia was also linked to elevated lipase.

Conclusions:

  • Elevations in pancreatic enzymes are frequent in children with DKA, though clinical pancreatitis is uncommon.
  • Peak pancreatic enzyme levels occur 12-24 hours post-treatment initiation.
  • Pancreatic enzyme elevation in DKA is associated with elevated BUN at presentation but not with abdominal pain.
Abstract

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