Emergency Cases Northwest Group

077 Chicken and Egg

Situation

Patient had normal HBA1C but still ended up in DKA after pancreatitis.

Background

A patient with alcohol issues presented with falls, found to be in DKA despite having a normal HBA1C 3 weeks ago. Additional results showed WCC 18 CRP 269, egfr 10 [new], Corrected Calcium 1.88 [low]. He had had some vomiting and minor upper abdominal pain preceding the falls, abdomen was only slightly tender.

Amylase eventually came back at 777, con-contrast CT abdomen showed acute pancreatitis.

Assessment

Acute pancreatitis had caused insulin deficiency which in turn caused DKA. Hypocalcaemia was also a clue towards pancreatitis.

Recommendation

Be aware that pancreatitis can be a cause of hyperglycaemia even in non-diabetic patients.

To complicate matters, patients with DKA may have elevated amylase from the DKA and not from a true pancreatitis!

One would differentiate the two situations by signs and symptoms, with or without imaging.

Ref https://www.sciencedirect.com/science/article/pii/S2376060524000762


PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group