Elevated serum amylase and lipase in pediatric diabetic ketoacidosis.
OBJECTIVE
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.


METHODS
Prospective cohort study.


METHODS
Three university-affiliated children's hospitals.


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


METHODS
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.


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.
Quiros
J Antonio
JA
Division of Gastroenterology, University of California Davis School of Medicine and the UC Davis Children's Hospital, USA.
Marcin
James P
JP
Kuppermann
Nathan
N
Nasrollahzadeh
Farid
F
Rewers
Arleta
A
DiCarlo
Joseph
J
Neely
E Kirk
EK
Glaser
Nicole
N
D000681:Amylases / Q000097:blood*; D001806:Blood Urea Nitrogen; D002648:Child; D016883:Diabetic Ketoacidosis / Q000097:blood*; D004573:Electrolytes / Q000097:blood; D005260:Female; D006785:Hospitals, University; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008049:Lipase / Q000097:blood*; D008274:Magnesium / Q000097:blood; D008297:Male; D010710:Phosphates / Q000097:blood; D011446:Prospective Studies; D014280:Triglycerides / Q000097:blood
D004573:Electrolytes; D010710:Phosphates; D014280:Triglycerides; D008049:Lipase; D000681:Amylases; D008274:Magnesium