Significance of increased serum elastase 1 level during the hyperosmolar hyperglycemic non-ketotic syndrome

An alteration in the serum elastase 1 level in a previously non-diabetic patient, who unfortunately developed the hyperosmolar hyperglycemic non-ketotic syndrome (HHNS), was observed after intravenous hyperalimentation for 6 days. The patient underwent the therapy because of the occurrence of severe persistent anorexia which appeared as a side effect of treatment of lung cancer with combined anticancer drugs. In parallel with progressive dehydration, levels of serum elastase 1 and urine glucose became greatly elevated at an earlier stage of HHNS. A slight increase in serum alpha 1-antitrypsin was observed. However, there were no significant changes in serum amylase activity and serum alpha 2-macroglobulin level before or during HHNS. The elevation of the serum elastase 1 level was considered to be due to serum electrolyte abnormalities and the defect of serum alpha 2-macro-globulin elevation. Rehydration therapy with half-normal saline solution immediately produced negative urine glucose, but the serum elastase 1 level only gradually normalized after improvement of HHNS.