Clinical characteristics of diabetic ketoacidosis complicated with acute pancreatitis in children and adolescents

Abstract

Objective To provide new evidence to avoid overdiagnosis of acute pancreatitis (AP) and unnecessary long-term fasting treatment in diabetic ketoacidosis (DKA) pediatric patients. Methods Children under the age of 18 suffered from DKA combined with elevated trypsin were enrolled in the Department of Endocrinology, Genetics and Metabolism of Beijing Children′s Hospitalfrom January 2015 to January 2019. Clinical data, including symptoms, serum amylase, lipase, lipid levels, pancreatic imaging, treatment options and clinical outcomes were analyzedretrospectively. The data were represented with median (upper and lower quartile). Results Among 330 DKA children admitted in 4 years, there were 38 (11.5%) DKA patients combined with elevated trypsin, 22 (6.7%) children whose trypsin were elevated more than 3 times. Sixteen (4.8%) patients with negative pancreatic imaging were defined as suspected AP, among which 14 patients in the absent of abdominal pain prognosed well without AP treatment. 1 out of 16 patients developed abdominal pain, which was relieved the next day after routine DKA treatment. Another patient presented abdominal pain received 12 days of AP treatment and despite having blood trypsin level increased when oral feeding began at the 14th day, she continued oral enteral nutrition withoutrelapse of AP symptoms. Six patients (1.8%) with positive imaging changes were defined as confirmed AP, among which 4 patients having abdominal pain received regular AP treatment and recovered from abdominal pain in 2-19 days respectively and their blood trypsin levels went below less than 3 times in 2-15 days. All of 6 patients had no recurrence of AP in the 5-32 months of follow-up. Conclusion Increased trypsin is common in children with DKA and it is usually associated with low incidence of AP and good prognosis. Key words: Diabetic ketoacidosis; Pancreatitis; Diagnosis; Prognosis