Type 1 or Type 2 DM

BMI?
Body weight loss for kg
polydipsia, polyphagia,
nocturia for months

2015 .|

Can lipase levels be elevat

ed in
DKA without pancreatitis?

What we already know=>

95% of serum lipase comes from the
pancreas
as opposed to 4050% of amylase
Lipase is considered a more specific marker
for pancreatitis. Elevation of lipase to levels
more than three times the upper limit of
normal is considered diagnostic of acute
pancreatitis.
Diagnostic criteria for Acute
Pancreatitis

Hyperlipasemia in diabetic ketoacidosis =>

Lipase elevations without CT evidence of
pancreatitis were noted in 24% (36/150) of
DKA cases.
Lipase levels were less than three times
normal in 15.3% (23/150) of the cases and
more than three times normal in 8.7%
(13/150) of the cases.
Nonspecific elevation of lipase levels was
noted to be more common than nonspecific
elevation of amylase levels (16.6%) in this
study.
Nonspecific
hyperamylasemia and hyperlipasemia in diabetic ketoacidosis: incidence
and correlation with biochemical abnormalities Amylase and Lipase in Diabetic
Ketoacidosis|Yadav et al, The American Journal of Gastroenterology 95, (November 2000)

Diabetic Ketoacidosis (DKA)

Definition

Metabolic emergency of type 1 DM or

severe stress in type 2 DM

Hyperglycemia

250~900mg/dl

DKA

pH: <6.9~7.2

Acidosis

Ketosis
(+) when dilution >1:8

Hyperosmolar Hyperglycemic State (HHS)

Definition
(1)Metabolic emergency in uncontrolled type 2 DM (Ofte
n previously undiagnosised)
(2)Severe hyperglycemia without significant ketosis
Effective osmolality =
[Na+] x 2 + Glucose (mg/dl) / 18

Hyperosmolality
Severe hyperglycemia
Dehydration

Endocrine Emergencies. Springer. 2014.

Discussion

HHS is associated with relative insulin deficiency, whe

re residual insulin prevents significant ketosis and aci
dosis

DKA involves absolute insulin deficiency, leading to ke

tonemia and metabolic acidosis

Discussion

HHS and DKA form a spectrum of disease involving v

arying severity of insulin deficiency

Discussion

Patients with DKA mostly have type 1 diabetes mellitu

s, which is associated with absolute insulin deficiency.
However, patients with advanced or severe type 2 dia
betes can also be at risk

HHS occurs almost exclusively in type 2 diabetes mell

itus, who continue to demonstrate some degree of ins
ulin secretion

Discussion
DKA and HHS have differing diagnostic criteria, but
numerous individuals have overlapping features

Effective osmolality = 2 x Na + Glucose / 18

Discussion
Initial evaluation of hyperglycemic emergency shoul
d include a survey of etiology

Differential diagnosis
Numerous conditions may mimic DKA and HHS