ESPE Abstracts

We report three cases of patients with pancreatitis that developed diabetes mellitus (DM). Case 1: 8,9 years old female, treated with valproic acid (VPA) for epilepsy. Who is admitted with 5 days of abdominal pain, vomiting and altered state of consciousness, in the ER the patient was dehydrated and initial labs showed glycemia of 423 mg/dl. She was admitted to the ICU, further studies

Results: amylase 502 U/L, lipase 1491 U/L, HbA1c 5.4%, pH 7.27, HCO3 21, a CT scan shows an acute pancreatitis (AP) Balthazar Score (BS) D; diabetes antibody panel result negative. She received intravenous hydration and continuous infusion with insulin 0.05 UI/kg/hour. Currently she maintains periodic controls, using insulin (0.27 UI/kg/day) with HbA1c 7%. Case 2: 10 years old male, he was diagnosed with PA and nonketotic hyperglycemia, 9 months later he was admitted again due to intense abdominal pain and vomiting, labs showed glycemia 308 mg/dL, amylase 53 U/L, lipase 13 U/L, HbA1c 14.48%, pH 7.31, HCO3 23.4, ketonemia 13.5 mg/dL; CT shows AP with BS C, been diagnosed with onset of DM with ketosis. Started treatment with glargine insulin. Now he maintains controls with regular glycemic metabolism on a total insulin dose of 0.74 UI/kg/day. His last HbA1c is 9.27% at 14 years old. Case 3: 10 years old female, who is admitted in the ER with abdominal pain and vomiting, labs showed glycemia 422 mg/dl, amylase 504 U/L, lipase 1386 U/L, pH 7.24, HCO3 17.5, ketonemia 24.9, HbA1c 5.76%; CT scan showed necrotizing AP BS D. She received continuous insulin infusion with 0.05 UI/kg/hr. Currently under regular monitoring, her last HbA1c 14.36% with an insulin dose of 0.72 UI/kg/day.

Discussion: DM is a frequent complication of chronic pancreatitis in adults. In children the more frequent causes are structural abnormalities, and it is documented transient hyperglycemia and glycosuria in children especially in severe AP. Overweight or obesity are risk factors in these patients for developing DM. Therefore, DM may occur after only a single episode of severe AP in children like patient 3, or during use of antiseizure medication as VPA like patient 1.

Conclusion: There are no specific guidelines for the treatment of DM secondary to AP, only very few reports. We suggest taking OGTT and studying endocrine pancreatic function in this group of patients.