Brent Hiramoto, MD1, Alexander Tonthat, MD1, Liam Hilson, MD1, Carlos Buitrago, MD1, Cameron Furey, MD1, Alice Lee, MD1, Yao Liu, MD1, Helen Lee, ANPC1, Ara B. Sahakian, MD2, James Buxbaum, MD, MS2; 1LAC + USC Medical Center, Los Angeles, CA; 2University of Southern California, Los Angeles, CA
Introduction: Admissions for acute pancreatitis and diabetic ketoacidosis (DKA) often overlap. Presenting features such as abdominal pain, elevated lipase levels, and anion gap acidosis may make differentiation and management challenging. To date, studies on admission and follow up outcomes in patients presenting with concomitant DKA and acute pancreatitis has been incompletely characterized. Methods: The clinical course of consecutive patients admitted to Los Angeles County + University of Southern California Hospital for acute pancreatitis between March 2015 and February 2020 was reviewed through April 2020. Patients with diabetes were identified and stratified by presence of DKA on admission. The outcomes of interest included the diagnosis of diabetes mellitus following index hospitalization in our hospital for acute pancreatitis, as well as general admission outcomes such as length of stay (LOS), intensive care unit admission (ICU), ICU LOS, organ failure, and pancreatitis severity as based on the Revised Atlanta Criterion. Results: Among a total cohort of 1081 patients with acute pancreatitis, 252 had diabetes mellitus (DM), and 37 of the patients with DM presented in DKA. Those presenting in DKA were more likely to develop moderately severe pancreatitis by the Revised Atlanta Classification (40.5% vs. 13.5%, p< 0.0001) and new onset renal failure (21.6% vs. 7.9%, p=0.01). Hypertriglyceridemia was more commonly identified as the etiology of acute pancreatitis in the DKA cohort (32.4% vs. 9.3%, p< 0.0001). Though rates of ICU admission were higher among DKA patients, this was largely due to the requirement for ICU monitoring for continuous insulin infusions at our center. Concomitant recurrent pancreatitis (37.8% vs. 14.4%, p=0.001) and chronic pancreatitis (13.5% vs. 3.3%, p=0.003) were significantly more common among patients presenting in DKA. Discussion: Acute pancreatitis with concomitant DKA is associated with greater pancreatitis severity as scored by the Revised Atlanta Criterion. These patients are also much more likely to have recurrent acute and chronic pancreatitis.
Table 1: Comparison of admission outcomes for acute pancreatitis between diabetics and diabetics presenting in DKA
Table 2: Recurrent pancreatitis and chronic pancreatitis among diabetics vs. diabetics presenting with DKA
Table 3: Comparison of imaging features among diabetics vs. diabetics presenting in DKA
Disclosures: Brent Hiramoto indicated no relevant financial relationships. Alexander Tonthat indicated no relevant financial relationships. Liam Hilson indicated no relevant financial relationships. Carlos Buitrago indicated no relevant financial relationships. Cameron Furey indicated no relevant financial relationships. Alice Lee indicated no relevant financial relationships. Yao Liu indicated no relevant financial relationships. Helen Lee indicated no relevant financial relationships. Ara Sahakian indicated no relevant financial relationships. James Buxbaum indicated no relevant financial relationships.