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Elevated serum amylase and lipase in pediatric diabetic ketoacidosis.
Pediatr Crit Care Med 2008; 9(4):418-22PC

Abstract

OBJECTIVES

Pancreatic enzyme concentrations are frequently elevated in children with diabetic ketoacidosis (DKA). We sought to determine the clinical and biochemical characteristics associated with patients with these elevations. Our hypothesis was that pancreatic enzyme elevations would be associated with biochemical markers of hypoperfusion.

DESIGN

Prospective cohort study.

SETTING

Three university-affiliated children's hospitals.

PATIENTS

We collected data on consecutive children <18 yrs of age hospitalized with the diagnosis of DKA.

INTERVENTIONS

Serum electrolyte and lactate concentrations and venous pH and Pco2 were measured every 3 hrs from hours 0 to 12 and then every 6 hrs until hour 24. Serum calcium, phosphate, and magnesium concentrations were measured every 6 hrs from hours 0 to 24. Serum amylase, lipase, and triglyceride concentrations were measured at hour 0 and then 12, 24, and 48 hrs after the initiation of therapy.

MEASUREMENTS AND MAIN RESULTS

We performed multivariable analyses to test for associations between clinical variables and pancreatic enzyme elevation in 67 children with DKA. Lipase was elevated in 21 (31%) and amylase in 16 (24%) of the children. Pancreatic enzyme values peaked 12-24 hrs after admission. There was no significant correlation between pancreatic enzyme elevation and abdominal pain. In multivariable analyses, an elevated blood urea nitrogen (BUN) concentration was associated with elevated serum amylase (odds ratio 1.04 per unit increase; 95% confidence interval, 1.01-1.09; p = .02), and elevated BUN concentrations and hypophosphatemia were associated with elevated serum lipase (odds ratio 1.04 per unit increase; 95% confidence interval, 1.00-1.08; p = .04; and odds ratio 0.35 per unit increase; 95% confidence interval, 0.15-0.81; p = .01, respectively).

CONCLUSIONS

Elevation of pancreatic enzymes is common in children with DKA, but clinical pancreatitis is rare. Pancreatic enzyme levels reach a peak 12-24 hrs after initiation of treatment for DKA. Pancreatic enzyme elevation is associated with increased BUN concentrations at presentation but is not associated with abdominal pain.

Authors+Show Affiliations

Division of Gastroenterology, University of California Davis School of Medicine and the UC Davis Children's Hospital, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18496406

Citation

Quiros, J Antonio, et al. "Elevated Serum Amylase and Lipase in Pediatric Diabetic Ketoacidosis." Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 9, no. 4, 2008, pp. 418-22.
Quiros JA, Marcin JP, Kuppermann N, et al. Elevated serum amylase and lipase in pediatric diabetic ketoacidosis. Pediatr Crit Care Med. 2008;9(4):418-22.
Quiros, J. A., Marcin, J. P., Kuppermann, N., Nasrollahzadeh, F., Rewers, A., DiCarlo, J., ... Glaser, N. (2008). Elevated serum amylase and lipase in pediatric diabetic ketoacidosis. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 9(4), pp. 418-22. doi:10.1097/PCC.0b013e318172e99b.
Quiros JA, et al. Elevated Serum Amylase and Lipase in Pediatric Diabetic Ketoacidosis. Pediatr Crit Care Med. 2008;9(4):418-22. PubMed PMID: 18496406.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Elevated serum amylase and lipase in pediatric diabetic ketoacidosis. AU - Quiros,J Antonio, AU - Marcin,James P, AU - Kuppermann,Nathan, AU - Nasrollahzadeh,Farid, AU - Rewers,Arleta, AU - DiCarlo,Joseph, AU - Neely,E Kirk, AU - Glaser,Nicole, PY - 2008/5/23/pubmed PY - 2009/3/10/medline PY - 2008/5/23/entrez SP - 418 EP - 22 JF - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JO - Pediatr Crit Care Med VL - 9 IS - 4 N2 - OBJECTIVES: Pancreatic enzyme concentrations are frequently elevated in children with diabetic ketoacidosis (DKA). We sought to determine the clinical and biochemical characteristics associated with patients with these elevations. Our hypothesis was that pancreatic enzyme elevations would be associated with biochemical markers of hypoperfusion. DESIGN: Prospective cohort study. SETTING: Three university-affiliated children's hospitals. PATIENTS: We collected data on consecutive children <18 yrs of age hospitalized with the diagnosis of DKA. INTERVENTIONS: Serum electrolyte and lactate concentrations and venous pH and Pco2 were measured every 3 hrs from hours 0 to 12 and then every 6 hrs until hour 24. Serum calcium, phosphate, and magnesium concentrations were measured every 6 hrs from hours 0 to 24. Serum amylase, lipase, and triglyceride concentrations were measured at hour 0 and then 12, 24, and 48 hrs after the initiation of therapy. MEASUREMENTS AND MAIN RESULTS: We performed multivariable analyses to test for associations between clinical variables and pancreatic enzyme elevation in 67 children with DKA. Lipase was elevated in 21 (31%) and amylase in 16 (24%) of the children. Pancreatic enzyme values peaked 12-24 hrs after admission. There was no significant correlation between pancreatic enzyme elevation and abdominal pain. In multivariable analyses, an elevated blood urea nitrogen (BUN) concentration was associated with elevated serum amylase (odds ratio 1.04 per unit increase; 95% confidence interval, 1.01-1.09; p = .02), and elevated BUN concentrations and hypophosphatemia were associated with elevated serum lipase (odds ratio 1.04 per unit increase; 95% confidence interval, 1.00-1.08; p = .04; and odds ratio 0.35 per unit increase; 95% confidence interval, 0.15-0.81; p = .01, respectively). CONCLUSIONS: Elevation of pancreatic enzymes is common in children with DKA, but clinical pancreatitis is rare. Pancreatic enzyme levels reach a peak 12-24 hrs after initiation of treatment for DKA. Pancreatic enzyme elevation is associated with increased BUN concentrations at presentation but is not associated with abdominal pain. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/18496406/Elevated_serum_amylase_and_lipase_in_pediatric_diabetic_ketoacidosis_ L2 - http://Insights.ovid.com/pubmed?pmid=18496406 DB - PRIME DP - Unbound Medicine ER -