Relation between acute pancreatitis and diabetic emergencies: a literature review

Authors

DOI:

https://doi.org/10.33448/rsd-v11i10.32620

Keywords:

Acute pancreatitis; Diabetic emergencies; Endocrinology.

Abstract

Acute pancreatitis (AP) is an inflammatory disease that affects the pancreas and peripancreatic tissues, while diabetic keatoacidosis (DKA) is a metabolic disorder resulting from a hyperglycemic state, with a state of metabolic acidosis and ketosis. About 77% of patients with DKA have signs of pancreatic disease. The objective of this study is to analyze the correlation of AP with diabetic emergencies and encourage medical professionals to explore this topic in view of the growing number of AP cases associated with DKA. This is an integrative literature review carried out through electronic searches in the following databases: PubMed, Scielo and Lilacs in March 2022. In these searches, the following descriptors were applied together with the Boolean operator AND: Pancreatitis AND Hyperosmolar Hyperglycemic State AND Diabetic Ketoacidosis, Pancreatitis AND Hyperosmolar Hyperglycemic State and Pancreatitis AND Diabetic Ketoacidosis. The guiding question to guide the correct search for articles was “What is the relation between acute pancreatitis and diabetic emergencies?” The research was carried out from a review of published studies on the correlation of DKA or hyperosmolar hyperglycemic state (HHS) with AP, and the association between cause and effect. In addition, most articles showed the development of hypertriglyceridemia (HTG) as a consequence of this hyperglycemic state. The reports follow two pathophysiological biases, the first correlating ketoacidosis as the cause of acute pancreatitis, and the second based on acute pancreatitis as the cause of diabetic ketoacidosis. It is concluded that the relationship between AP and diabetic emergencies appears in different ways. There are cases in which pancreatic inflammation is responsible for complications and cases in which it is a consequence of these. Hypertriglyceridemia is also present and can often be the cause of acute pancreatitis in conjunction with ketoacidosis.

References

Alfishawy, M., Nassar, M., Mohamed, M., Fatthy, M., & Elmessiery, R. M. (2021). New-onset Type 1 Diabetes Mellitus with Diabetic Ketoacidosis and Pancreatitis in a Patient with COVID-19. Scientific African, 13(20), e00915. https://doi.org/10.1016/j.sciaf.2021.e00915

Amblee, A., Mohananey, D., Morkos, M., Basu, S., Abegunde, A. kunle T., Ganesh, M., Bhalerao, N., George, A. M., Jain, M., & Fogelfeld, L. (2018). ACUTE PANCREATITIS IN PATIENTS WITH SEVERE HYPERTRIGLYCERIDEMIA IN A MULTI-ETHNIC MINORITY POPULATION. Endocrine Practice, 24(5), 429–437. https://doi.org/10.4158/ep-2017-0178

Badwal, K., Tariq, T., & Peirce, D. (2018). Dapagliflozin-Associated Euglycemic Diabetic Ketoacidosis in a Patient Presenting with Acute Pancreatitis. Case Reports in Endocrinology, 2018(1), 1–4. https://doi.org/10.1155/2018/6450563

Bao, Y. K., Ganesan, V. C., Jiang, W., Lin, L., Brown, N. R., Steigerwalt, K. E., & Yu, A. Z. (2019). Muscle relaxant induced pancreatitis leading to hyperosmolar hyperglycemic state. Oxford Medical Case Reports, 2019(3). https://doi.org/10.1093/omcr/omz012

Bouchaala, K., Bahloul, M., Bradii, S., Kallel, H., Chtara, K., & Bouaziz, M. (2020). Acute Pancreatitis Induced by Diabetic Ketoacidosis with Major Hypertriglyceridemia: Report of Four Cases. Case Reports in Critical Care, 2020(1), e7653730. https://doi.org/10.1155/2020/7653730

Chaudhry, A., Biggiani, C., Afzal, M., Chaudhry, S., & Vwich, Y. (2021). Acute Pancreatitis-Induced Euglycemic Diabetic Ketoacidosis. Cureus, 13(6). https://doi.org/10.7759/cureus.15949

Donelli, D., Morini, L., Trenti, C., Santi, R., Arioli, D., & Negri, E. A. (2018). Plasma Exchange for the Treatment of Transient Extreme Hypertriglyceridemia Associated with Diabetic Ketoacidosis and Acute Pancreatitis. European Journal of Case Reports in Internal Medicine, 5(LATEST ONLINE), 1. https://doi.org/10.12890/2018_000853

Duarte, A. S., Roque, A. B. B., Gouveia, M. A., Pereira, J. P., Brito, A. P. S. O., & Garcia, H. C. R. (2019). Fisiopatologia e tratamento da pancreatite aguda: revisão de literatura. Pará Research Medical Journal, 3(1). https://doi.org/10.4322/prmj.2019.006

Ferreira, A. M., Santos, J. C., Ferreira, S., Leite, A. L., & Campos, R. A. (2020). Pancreatitis and diabetic ketoacidosis in an adolescent treated with sertraline. NASCER E CRESCER - BIRTH AND GROWTH MEDICAL JOURNAL, 29(4), 209–211. https://doi.org/10.25753/BirthGrowthMJ.v29.i4.17934

Fu, Y., Liu, X., Cui, B., Wang, C., Liu, Z., & Zhao, B. (2022). Clinical Characteristics of Concomitant Diabetic Ketoacidosis in Type 2 Diabetes Patients with Acute Pancreatitis. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Volume 15(1), 111–119. https://doi.org/10.2147/dmso.s336619

Ho, J. S. Y., Mui, B., Sia, C.-H., Djohan, A. H., Mok, S.-F., Chan, M. Y., & Ambhore, A. A. (2020). A 78-year-old male with inferior ST-segment elevation on electrocardiogram, diabetic ketoacidosis and acute pancreatitis. Cardiovascular Endocrinology & Metabolism, 9(4), 186–188. https://doi.org/10.1097/xce.0000000000000205

Huang, Z., Xu, Z., Xu, R., Huang, L., Xu, X., & Lai, X. (2020). Whole exome sequencing identifies three novel gene mutations in patients with the triad of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis. Journal of Diabetes, 13(3), 200–210. https://doi.org/10.1111/1753-0407.13100

Iwamoto, Y., Tatsumi, F., Kohara, K., Shimoda, M., Nakanishi, S., Mune, T., Kaku, K., & Kaneto, H. (2022). Dramatic recovery without steroid therapy and withdrawal from insulin therapy in a subject with hyperglycemic and hyperosmolar syndrome and depletion of insulin secretory capacity induced by type 2 autoimmune pancreatitis. Medicine, 101(2), e28609. https://doi.org/10.1097/md.0000000000028609

Jameel, P. Z., Lohiya, S., Dongre, A., Damke, S., & Lakhkar, B. B. (2020). Concurrent diabetic ketoacidosis and pancreatitis in Paediatric acute lymphoblastic leukemia receiving L-asparaginase. BMC Pediatrics, 20(1), 228. https://doi.org/10.1186/s12887-020-02136-3

Jeong, C., Yang, Y. S., Son, H.-S., & Sohn, T.-S. (2022). Diabetic ketoacidosis and acute pancreatitis in a patient with agenesis of the dorsal pancreas. The Korean Journal of Internal Medicine, 37(2), 484–485. https://doi.org/10.3904/kjim.2021.374

Kong, M. T., Nunes, M. P., & Leong, K. F. (2021). Diabetic ketoacidosis with acute severe hypertriglyceridaemia-induced pancreatitis as first presentation of type 2 diabetes. BMJ Case Reports, 14(4), e239727. https://doi.org/10.1136/bcr-2020-239727

Kravetz, A. M., Sanghavi, P., Bhargava, V., Shi, R. Z., & Nally, L. M. (2021). Plasmapheresis as an Early Treatment for Severe Hypertriglyceridemia, Acute Pancreatitis, and Diabetic Ketoacidosis. AACE Clinical Case Reports, 7(5), 315–319. https://doi.org/10.1016/j.aace.2021.03.009

Lin, C.-H., Yeh, N.-C., Wang, J.-J., Ho, C.-H., Her, S.-H., Tsay, W.-I., & Chien, C.-C. (2020). Effect of Chronic Pancreatitis on Complications and Mortality in DM Patients: A 10-year Nationwide Cohort Study. The Journal of Clinical Endocrinology & Metabolism, 105(3), e739–e745. https://doi.org/10.1210/clinem/dgaa035

Lu, S., Wei, D., Yin, C., Xiong, J., Zhu, L., Yan, S., & Meng, R. (2021). Correlation between PCT, 25(OH)D, PTX-3, AMS levels and the severity of diabetic ketoacidosis complicated by pancreatitis. BMC Endocrine Disorders, 21(1). https://doi.org/10.1186/s12902-021-00792-9

Mathuram Thiyagarajan, U., Ponnuswamy, A., & Chung, A. (2019). An enigmatic triad of acute pancreatitis, diabetic ketoacidosis and hypertriglyceridaemia: who is the culprit? BMJ Case Reports, 12(7), e217272. https://doi.org/10.1136/bcr-2016-217272

Monica Joustra, Janneke Raidt, Florens Droog, & Thiemo Veneman. (2020). Diabetic Ketoacidosis, Hypertriglyceridemia and Abdominal Pain due to Acute Pancreatitis Complicated by Non-immune Haemolytic Anaemia. European Journal of Case Reports in Internal Medicine, 7(LATEST ONLINE). https://doi.org/10.12890/2020_002085

Nakajima, M., Shirokawa, M., Nakano, T., & Goto, H. (2018). Fulminant type 1 diabetes mellitus with remarkable elevation of serum pancreatic enzymes. The American Journal of Emergency Medicine, 36(7), 1326.e3–1326.e5. https://doi.org/10.1016/j.ajem.2018.04.026

Naqvi, S. M. A., Haider, S., Patel, A., Muhammad, S., & Yousaf, A. (2021). Hypertriglyceridemia-Induced Pancreatitis Complicated by Diabetic Ketoacidosis. Cureus, 13(11). https://doi.org/10.7759/cureus.19985

Narala, B., Al-Tkrit, A., David, S., Alataby, H., & Nfonoyim, J. (2021). A Fatal Case of Hypertriglyceridemia-Induced Acute Pancreatitis in a Patient With Diabetic Ketoacidosis. Cureus, 13(5). https://doi.org/10.7759/cureus.14968

Park, H., Kim, M.-S., Kim, J., Lee, S.-M., Cho, S. Y., Yoo, E.-G., & Jin, D.-K. (2022). Hypertriglyceridemia with acute pancreatitis in a 14-year-old girl with diabetic ketoacidosis. Annals of Pediatric Endocrinology & Metabolism, 27(1), 73–77. https://doi.org/10.6065/apem.2040250.125

Ramachandran, V., Vila, D. M., Cochran, J. M., Caruso, A. C., & Balchandani, R. (2018). Acute pancreatitis secondary to hypertriglyceridemia precipitated by diabetic ketoacidosis in a previously undiagnosed ketosis-prone patient with diabetes mellitus. Baylor University Medical Center Proceedings, 31(2), 189–191. https://doi.org/10.1080/08998280.2018.1435123

Rhmari Tlemçani, F. Z., Delsa, H., Elamari, S., Rouibaa, F., & Chadli, A. (2022). Diabetic Ketoacidosis With Acute Metabolic Pancreatitis: Two Serious Cases. Cureus, 14(1). https://doi.org/10.7759/cureus.20987

Richardson, A., & Park, W. G. (2021). Acute pancreatitis and diabetes mellitus: a review. The Korean Journal of Internal Medicine, 36(1), 15–24. https://doi.org/10.3904/kjim.2020.505

Shaikh, B. H., Sohaib, M., Alshantti, R., Barrera, F., Faridi, F. S., & Murvelashvili, N. (2018). Diabetic Ketoacidosis and the Domino Effect. American Journal of Case Reports, 19(1), 1342–1344. https://doi.org/10.12659/ajcr.911747

Sharma, P. K., Kumar, M., & Yadav, D. K. (2017). Severe Hypertriglyceridemia Causing Pancreatitis in a Child with New-onset Type-I Diabetes Mellitus Presenting with Diabetic Ketoacidosis. Indian Journal of Critical Care Medicine, 21(3), 176–181. https://doi.org/10.4103/ijccm.ijccm_281_16

Shor, D., Harrison, S., Anacker, K., & Wiley, J. (2021). Acute Pancreatitis as a Sequela of Hypertriglyceridemia Due to Hyperosmolar Hyperglycemic Syndrome. Cureus, 13(11). https://doi.org/10.7759/cureus.19640

Timilsina, S., Timilsina, S., Mandal, A., Paudel, R., & Gayam, V. (2019). Triad of Diabetic Ketoacidosis, Hypertriglyceridemia, and Acute Pancreatitis: Severity of Acute Pancreatitis May Correlate with the Level of Hypertriglyceridemia. Cureus, 11(6). https://doi.org/10.7759/cureus.4930

Vitelli, A., Apuzzi, V., Calderaro, F., Fattoruso, O., & Bassi, V. (2020). A Triad of Ketoacidosis, Hypertriglyceridemia, and Acute Pancreatitis Associated With Sugar-Sweetened Soft Drinks Abuse in a Caucasian Patient With Undiagnosed Type 2 Diabetes Mellitus. Cureus, 12(5). https://doi.org/10.7759/cureus.8299

Wang, Y., Attar, B. M., Hinami, K., Jaiswal, P., Yap, J. E., Jaiswal, R., Devani, K., Simons-Linares, C. R., & Demetria, M. V. (2017). Concurrent Diabetic Ketoacidosis in Hypertriglyceridemia-Induced Pancreatitis. Pancreas, 46(10), 1336–1340. https://doi.org/10.1097/mpa.0000000000000937

Wei, D., Yin, C., Lu, S., Xiong, J., Zhu, L., Yan, S., & Meng, R. (2021). The effect of insulin pump combined with ulinastatin on the levels of PCT, TG, PTX-3, and CX3CL1 in patients with diabetic ketoacidosis and pancreatitis. Medicine, 100(14), e25141. https://doi.org/10.1097/md.0000000000025141

Yuan, S., Liao, J., Cai, R., Xiong, Y., Zhan, H., & Zheng, Z. (2020). Acute pancreatitis concomitant with diabetic ketoacidosis: a cohort from South China. The Journal of International Medical Research, 48(3), 300060520912128. https://doi.org/10.1177/0300060520912128

Published

26/07/2022

How to Cite

MUNDOCA, M. P. .; LIMA, J. L. F. .; SOUZA FILHO, J. R. de .; OLIVEIRA, M. de J. .; MENDES, S. N. .; COSTA, V. G. A. e S. . Relation between acute pancreatitis and diabetic emergencies: a literature review. Research, Society and Development, [S. l.], v. 11, n. 10, p. e156111032620, 2022. DOI: 10.33448/rsd-v11i10.32620. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/32620. Acesso em: 23 nov. 2024.

Issue

Section

Review Article