Elevated serum amylase and lipase in pediatric diabetic ketoacidosis

J. Antonio Quiros, James P Marcin, Nathan Kuppermann, Farid Nasrollahzadeh, Arleta Rewers, Joseph DiCarlo, E. Kirk Neely, Nicole Glaser

Research output: Contribution to journalArticle

18 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)418-422
Number of pages5
JournalPediatric Critical Care Medicine
Volume9
Issue number4
DOIs
StatePublished - Jul 2008

Fingerprint

Diabetic Ketoacidosis
Amylases
Lipase
Pediatrics
Enzymes
Serum
Blood Urea Nitrogen
Odds Ratio
Confidence Intervals
Abdominal Pain
Hypophosphatemia
Pancreatitis
Electrolytes
Lactic Acid
Cohort Studies
Biomarkers
Prospective Studies
Therapeutics

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 journalArticle

Quiros, J. Antonio ; Marcin, James P ; Kuppermann, Nathan ; Nasrollahzadeh, Farid ; Rewers, Arleta ; DiCarlo, Joseph ; Neely, E. Kirk ; Glaser, Nicole. / Elevated serum amylase and lipase in pediatric diabetic ketoacidosis. In: Pediatric Critical Care Medicine. 2008 ; Vol. 9, No. 4. pp. 418-422.
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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).",
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AU - Rewers, Arleta

AU - DiCarlo, Joseph

AU - Neely, E. Kirk

AU - Glaser, Nicole

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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).

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