Acta Diabetologica

, Volume 36, Issue 1–2, pp 39–44 | Cite as

Changes in serum amylase, lipase and leukocyte elastase during diabetic ketoacidosis and poorly controlled diabetes

  • M.C. Vantyghem
  • S. Haye
  • M. Balduyck
  • C. Hober
  • P.M. Degand
  • J. Lefebvre
Original

Abstract

Diabetic ketoacidosis (DKA) is frequently associated with pancreatic enzyme abnormalities. In order to determine the main factors that lead to this increase, serum total amylase (TA), pancreatic amylase (PA), lipase (L) and leukocyte elastase (LE), an early predictor of acute pancreatitis, were measured in four groups of patients on admission. Group 1 consisted of 52 patients with DKA (age: 41.9 ± 19.2 years; blood glucose (Glc): 27.4 ± 11.5 mmol/L; pH: 7.20 ± 0.16; plasma bicarbonate: 10.5 ± 6.2 mmol/L; blood urea nitrogen (BUN): 0.60 ± 0.44 g/L; HbA1C: 12.5% ± 2.8%). Group 2 consisted of 90 patients with poorly controlled non-ketotic diabetes (age: 53.4 ± 16.0; Glc: 14.3 ± 0.6; HCO3: 26.6 ± 3.2; BUN: 0.38 ± 0.20; HbA1C: 11.3 ± 2.1). Group 3 consisted of 22 patients with well-controlled diabetes (age: 53.7 ± 12.8; Glc: 10.1 ± 5.2; HCO3: 27.4 ± 3.8; BUN: 0.36 ± 0.19; HbA1C: 6.8 ± 0.8). Group 4 (controls) comprised 27 non-diabetic patients (age: 46.0 ± 15.0; Glc: 4.9 ± 0.5; HCO3: 28.4 ± 2.5; BUN: 0.30 ± 0.16; HbA1C: 5.2 ± 0.7) (means ± SD). Increased enzyme activities were more frequent in group 1 (TA: 30.7; PA: 27.0; L: 36.5; LE: 73%) than in groups 2 (TA: 8.9; PA: 7.1; L: 8.9; LE: 45.5%), 3 (TA: 13.6; PA: 9.0; L: 18.1; LE: 31.8%) and 4 (TA: 7.0; PA: 3.0; L: 0.0; LE: 29.6%). Mean serum enzyme activities were significantly different in the 4 groups (ANOVA, P < 0.01) and were higher in group 1 than in groups 2, 3 and 4 (Student's t-test; group 1 vs 2 or 3 or 4: P < 0.001). In groups 1 + 2 + 3 + 4 (all patients), the four enzymes correlated with one another and also with Glc, BUN and HCO3 (P < 0.001). In group 1, TA correlated negatively with HCO3 (P < 0.001) and pH (P < 0.05); PA and L correlated positively with Glc and BUN (P < 0.01) and negatively with HCO3 (respectively, p < 0.01 and 0.05). PA correlated positively with pH (P < 0.01); LE correlated with Glc (P < 0.05) and BUN (P < 0.01). In conclusion, this study suggests that the serum levels of pancreatic enzymes increase with the degree of diabetic disequilibrium, and mainly correlate with metabolic factors such as hyperglycaemia, dehydration and acidosis. Increased pancreatic enzyme activities in patients with DKA, even in combination with abdominal pain, should not be diagnosed as acute pancreatitis; this could be important, particularly for younger clinicians.

Key words Serum pancreatic enzymes Diabetic ketoacidosis 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • M.C. Vantyghem
    • 1
  • S. Haye
    • 1
  • M. Balduyck
    • 2
  • C. Hober
    • 1
  • P.M. Degand
    • 2
  • J. Lefebvre
    • 1
  1. 1.Department of Endocrinology and Metabolic Diseases, Clinique Marc Linquette, USN “A”, 6 Rue du Professeur Laguesse, F-59037 Lille Cédex, FranceFR
  2. 2.Laboratory of Biochemistry, CHRU, F-59037 Lille Cédex, FranceFR

Personalised recommendations