Abstract
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 PCO 2 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. (Pediatr Crit Care Med 2008; 9:418 -422).
| Original language | English (US) |
|---|---|
| Pages (from-to) | 418-422 |
| Number of pages | 5 |
| Journal | Pediatric Critical Care Medicine |
| Volume | 9 |
| Issue number | 4 |
| DOIs | |
| State | Published - Jul 2008 |
Fingerprint
Keywords
- Blood urea nitrogen
- Diabetes
- Diabetic ketoacidosis
- Pancreatic enzymes
- Pancreatitis
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Critical Care and Intensive Care Medicine
Cite this
Elevated serum amylase and lipase in pediatric diabetic ketoacidosis. / Quiros, J. Antonio; Marcin, James P; Kuppermann, Nathan; Nasrollahzadeh, Farid; Rewers, Arleta; DiCarlo, Joseph; Neely, E. Kirk; Glaser, Nicole.
In: Pediatric Critical Care Medicine, Vol. 9, No. 4, 07.2008, p. 418-422.Research output: Contribution to journal › Article
}
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 - 2008/7
Y1 - 2008/7
N2 - 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 PCO 2 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. (Pediatr Crit Care Med 2008; 9:418 -422).
AB - 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 PCO 2 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. (Pediatr Crit Care Med 2008; 9:418 -422).
KW - Blood urea nitrogen
KW - Diabetes
KW - Diabetic ketoacidosis
KW - Pancreatic enzymes
KW - Pancreatitis
UR - http://www.scopus.com/inward/record.url?scp=61749099671&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=61749099671&partnerID=8YFLogxK
U2 - 10.1097/PCC.0b013e318172e99b
DO - 10.1097/PCC.0b013e318172e99b
M3 - Article
C2 - 18496406
AN - SCOPUS:61749099671
VL - 9
SP - 418
EP - 422
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
SN - 1529-7535
IS - 4
ER -