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If so, by what mechanism do patients with DKA develop acute pancreatitis?,& F  Review of DKADiagnosis of DKA requires: 1/ Random blood glucose of >250 2/ PH <7.30 and/or bicarbonate <18 3/ + serum (B-hydoxybutarate)/urine ketones,nPrecipitating factors%Is acute pancreatitis assoc with DKA?&&& Several case reports emphasize development of diabetic coma as rare complication of severe A.P. Others have documented assoc of A.P. w/ HONK diabetic coma. Coexisting A.P and DKA have been reported. #Clinically difficult to distinguishHThe clinical significance of this bidirectional cause and effect relationship of A.P. w/ DKA is complex. DKA is known to cause elev. of amylase/lipase. Clinical diagnosis of pancreatitis is difficult w/o CT findings present. Sx s of abd pain in pt w/ DKA may occur with or w/o pancreatitis.&jjt]G ()   Association of Diabetic Ketoacidosis and Acute Pancreatitis: Observations in 100 Consecutive Episodes of DKA. Nair, et al. Am J of Gastroenterology. 2000(p+,  `OBJECTIVE: evaluate the incidence, pathogenesis, and prognosis of A.P. in DKA. METHODS: prospective evaluation of 100 consecutive episodes of DKA during 13 mo period in 1998 at univ hospital in New York, NY. Pt s were determined to have A.P. based on CT scan findings. (enlargement of pancreas, +pancreatic necrosis, or peripancreatic fluid collections)  Gy, Association of Diabetic Ketoacidosis and Acute Pancreatitis: Observations in 100 Consecutive Episodes of DKA. Nair, et al. Am J of Gastroenterology. 2000 o,,  `TRESULTS: 11% of pt s had A.P. Etiology: 4 pts was hypertriglyceridemia, 2 pts was EtOH, 1 pt was drug induced; 4 were idiopathic. Lipase elevation was noted in 29%, amylase elevation in 21% of pt s with DKA. (enzymes were similarly elevated in those who did NOT have CT findings c/w pancreatitis), " "P2     ConclusionsDKA may mask coexisting A.P., which occurs in at least 10-15% of cases. Pathogenesis of A.P. in DKA varies, but some assoc with transient and profound hyperlipidemia. Ranson s criteria do not apply prognostically to assess A.P. in pt s with DKA. $R>#   ConclusionsThere is significant overlap betw presentation of A.P. and DKA, thus the diagnosis can be difficult. Important to distinguish because presence of A.P. can worsen the severity of DKA by worsening of the intravascular volume depletion. More aggressive volume repletion needed In DKA, oral feedings would be resumed once ketosis is controlled. But if A.P. present, feeding may be detrimental. Also need to monitor pt closely for consequences of A.P. (including ARDS, pancreatic necrosis and infection). BP(PP( Take home pointsCT scan may be necessary to dx pancreatitis in pt s with DKA. Should we be screening pt s w/ DKA for A.P. by checking amy/lip and triglycerides? (no data at this time) Do not ignore abd pain in DKA, may be concurrent A.P. 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"Systemi-@Times New Roman-. 332 Morning Report/ #.-@Arial-. 2 p3/22/07  .-՜.+,D՜.+,8    On-screen ShowLUHSree  ArialTimes New Roman WingdingsVerdanaLayers General Medicine Morning ReportClinical QuestionsReview of DKASlide 4Precipitating factors&Is acute pancreatitis assoc with DKA?$Clinically difficult to distinguish Association of Diabetic Ketoacidosis and Acute Pancreatitis: Observations in 100 Consecutive Episodes of DKA. Nair, et al. Am J of Gastroenterology. 2000Association of Diabetic Ketoacidosis and Acute Pancreatitis: Observations in 100 Consecutive Episodes of DKA. Nair, et al. Am J of Gastroenterology. 2000 Conclusions ConclusionsTake home points  Fonts UsedDesign Template Slide Titles L 8@ _PID_HLINKSA http://www.utdol.com/utd/content/image.do?imageKey=endo_pix/ada_cr2.htm&title=ADA%20criteria%20DKA%20HHS&altImageKey=&altTitle=&linkTitle=ADA%20criteria%20DKA%20HHS#http://www.utdol.com/utd/content/image.do?imageKey=endo_pix/ada_cr2.htm&title=ADA%20criteria%20DKA%20HHS&altImageKey=&altTitle=&linkTitle=ADA%20criteria%20DKA%20HHS#_709903709903  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnoprstuvwxz{|}~Root EntrydO)PicturesCurrent UserSummaryInformation(qPowerPoint Document(DocumentSummaryInformation8yRoot EntrydO)0vl@PicturesCurrent User8SummaryInformation(q _kmuccinokmuccino