# Acute Pancreatitis and Diabetic Ketoacidosis: Special Considerations in Diagnosis and Management

## TL;DR

This paper discusses the challenges of diagnosing acute pancreatitis in patients with diabetic ketoacidosis and highlights management strategies through two adolescent case studies.

## Contribution

The paper provides insights into the management of co-occurring acute pancreatitis and diabetic ketoacidosis in adolescents with type 1 diabetes.

## Key findings

- Two adolescents with type 1 diabetes presented with both DKA and AP, showing overlapping symptoms and lab findings.
- Imaging confirmed pancreatitis after initial DKA symptoms resolved, requiring tailored treatment including TPN and pain management.
- Unnecessary testing and treatments should be avoided in such cases to prevent complications.

## Abstract

Acute pancreatitis (AP) and diabetic ketoacidosis (DKA) can influence each other, and diagnosing AP in DKA patients is challenging due to overlapping symptoms and laboratory findings.

This case series discusses two adolescents with type 1 diabetes who presented with severe abdominal pain and were diagnosed with both DKA and AP. Both had a history of poor medication adherence. Initial labs showed hyperglycemia, acidosis, and elevated pancreatic enzymes. While DKA symptoms resolved quickly, abdominal pain persisted and imaging confirmed pancreatitis. Treatment included fluids, insulin, pain management, and symptoms management for pain as well as the use of antibiotics and total parenteral nutrition (TPN). Both patients improved gradually and were discharged with advice for better diabetes control.

Diagnosing AP in DKA is difficult because of similar symptoms and laboratory findings. Imaging can help but is not always definitive. Unnecessary pancreatic enzyme testing and the use of antibiotics, opioid analgesia, and TPN treatments, if not clinically indicated, should be avoided.