Outcomes of Patients Presenting With Acute Pancreatitis and Diabetic Ketoacidosis

Introduction: There is limited understanding of the clinical course of concurrent diabetic ketoacidosis (DKA) and acute pancreatitis given its relative rarity. Preliminary work indicates that it poses a challenge with intravascular volume repletion strategies, glucose management, and initiation of a diet. We aim to explore the management and outcomes of concurrent DKA and acute pancreatitis. Methods: We analyzed all unique patients presenting with acute pancreatitis to Los Angeles General Medical Center captured in a prospective cohort. Our main predictor was the existence of DKA based on clinical and laboratory findings. Our primary outcome was development of moderate and severe pancreatitis according to the Revised Atlanta Criteria, and our secondary outcomes were development of SIRS, ICU admission, and mortality. Linear and logistic multivariate regression analyses were performed, controlling for both patient (such as age, sex, ethnicity) and clinical (eg etiology of pancreatitis, comorbidities) factors. Results: Among 1,284 unique patients who presented to Los Angeles General Medical Center with acute pancreatitis between January 2015 and March 2021, 64 (5.0%) patients had concurrent DKA. Those with DKA were more likely to have comorbidities such as dyslipidemia (29% vs 12%, P < 0.01) and diabetes. They also were more likely to present with acute encephalopathy (23% vs 5%, P < 0.01) and acute renal failure. Patients with DKA received more fluids in the first 24 hours (5.8 (±2.7) versus 3.5 (±2.0)L without DKA (P < 0.01)). In multivariate analysis, DKA patients were more likely to have moderate and severe pancreatitis (OR 2.5 95% CI 1.24–4.01) and require ICU admissions (OR 4.74 95% CI 1.57–14.3) than those without DKA (Table 1). Conclusion: Patients with DKA and acute pancreatitis are at higher risk for moderate and severe pancreatitis and necessity of ICU admission. While particularly aggressive volume resuscitation has been espoused for these patients, a more structured, goal-directed strategy could mitigate some of this observed morbidity. Table 1. - DKA in Patients With Acute Pancreatitis No DKA N = 1220 DKA N = 64 Age Mean± SD 45 ± 15.7 40 ± 12.1 Sex 643 males (53%) 49 males (77%) Diabetes 265 (22%) 48 (75%) HLD 146 (12%) 18 (29%) Admission Glucose 153 ± 84.2 544 ± 327.6 Admission Anion Gap 16.8 ± 8.5 27.2 ± 9.2 Admission Cr 1.0 ± 1.3 1.4 ± 1.1 SIRS on presentation 342 (28%) 43 (67%) Fluid Management Fluids given in first 24H Mean± SD (Mean Difference -2281mL) 3507 mL ± 2015 5788 mL ± 2660 Clinical Outcomes in patients with AKI Moderate Severe Pancreatitis OR (95% CI) 2.62 (1.32–5.22) ICU Admissions OR (95% CI) 4.62 (1.53–13.90)