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

Diabetic ketoacidosis (DKA) is frequently associated with pancreatic enzyme abnormalities. In order to determine the main factors that lead to this in crease, serum total amylase (TA), pancreatic amylase (PA), lipase (L) and l eukocyte elastase (LE), an early predictor of acute pancreatitis, were meas ured in four groups of patients on admission. Group 1 consisted of 52 patie nts 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 u rea nitrogen (BUN): 0.60 +/- 0.44 g/L; HbA(1C): 12.5% +/- 2.8%). Group 2 co nsisted 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; Hb A(1C): 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; HbA(1C): 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; HbA(1C): 5.2 +/- 0.7) (means +/- SD). Increased enzy me activities were more frequent in group 1 (TA: 30.7; PA: 27.0; L: 36.5; L E: 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 (Stu dent's t-test; group 1 vs 2 or 3 or 4: P < 0.001). In groups 1 + 2 + 3 + 4 tall 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 H CO3- (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 s erum levels of pancreatic enzymes increase with the degree of diabetic dise quilibrium, and mainly correlate with metabolic factors such as hyperglycae mia, dehydration and acidosis. Increased pancreatic enzyme activities in pa tients with DKA, even in combination with abdominal pain, should not be dia gnosed as acute pancreatitis; this could be important, particularly for you nger clinicians.