Elevated serum lipase in diabetic ketoacidosis: how significant is the finding a case report

Aim: Asses the significance of elevated serum lipase in Diabetic ketoacidosis Methadology: Serum sample of a female patient known to have Diabetes Mellitus, presenting to ER with complaints of recurrent episodes of vomiting, abdominal pain was taken and routine biochemical tests including a spot urine dipstick test, an arterial blood gas analysis along with serum amylase and lipase was sent. Patient was subjected to ultrasound imaging. The results obtained were analysed. Result: It was found that along with the presence of an elevated blood glucose (304mg/dl), urine was positive for ketone bodies with low bicarbonate levels. The serum amylase was found to be normal but significantly the serum lipase was found to be three times the upper reference range (180 U/L). The abdominal ultrasound was found to be normal without any evidence of pancreatic inflammation. Conclusion: Diabetic ketoacidosis is one of the most common complications of diabetes mellitus (especially type 1). It can often be the presenting symptom in a previously undiagnosed patients. Though occurance of pancreatitis is uncommon phenomenon in the setting of DKA but it is not rare either. Studies conducted have shown that both DKA can precipitate pancreatitis and vice versa. But a very significant finding has been that in 16-25% of patients having DKA can have an elevated serum lipase (≥ 3 times the URL) which is considered diagnostic of acute pancreatitis with or without an elevated serum amylase.