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ype 1 or ype 2 DM
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2015 .|
BMI?Body weight loss for kgpolydipsia, polyphagia,nocturia for months
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4/22
4
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5/22
5
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Can !pa"e e#e" $e ee#a%
e& !n
D'( )!%*o+% pan,rea%!%!"-
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What we already know=> 95% of serum lipase comes from the
pancreas as opposed to 4050% of amlase !ipase is considered a more speci"c mar#er
for pancreatitis. $leation of lipase to leelsmore than three times the upper limit ofnormal is considered dia&nostic of acutepancreatitis.
'ia&nostic criteria for AcutePancreatitis .
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Nonspecific hyperamylasemia and hyperlipasemia in diabetic ketoacidosis: incidence
and correlation with biochemical abnormalities Amylase and Lipase in DiabeticKetoacidosis|Yadav et al, The American Journal of Gastroenterology 95, (November !!!"
Hyperlipasemia in diabetic ketoacidosis => !ipase eleations (ithout )* eidence ofpancreatitis (ere noted in 24%+,-150/ of' cases.
!ipase leels (ere less than three timesnormal in !"#%+2,150/ of the cases andmore than three times normal in $"%+1,150/ of the cases.
onspeci"c eleation of lipase leels (asnoted to 3e more common than nonspeci"celeation of amlase leels +1-.-%/ in thisstud.
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D!a$e%!, 'e%oa,!&o"!" /D'(0
Hyperglycemia
Acidosis Ketosis
DKA
DefinitionMetabolic emergency of type 1 DMorsevere stress in type 2 DM
250~900mg/dl
pH !"#9~$#2%&' ()en dil*tion +,-
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ypero"oar yper3y,e!, 4%a%e /40
De5!n!%!on . /10Me%a$o!, eer3en,y !n +n,on%roe& %ype 2 DM /65%e
n pre#!o+"y +n&!a3no"!"e&0
/204e#ere *yper3y,e!a )!%*o+% "!3n!5!,an% 7e%o"!"
Hyperosmolality
.evere )yperglycemia
De)ydration
ffective osmolality
1a&3 4 2 & l*cose %mg/dl' / ,-
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Endocrine Emergencies. Springer. 2014.
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Discussion HH. is associated (it) relative ins*lin deficiency6 ()e
re resid*al ins*lin prevents significant 7etosis and acidosis
DKA involves absol*te ins*lin deficiency6 leading to 7e
tonemia and metabolic acidosis
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Discussion HH. and DKA form a spectr*m of disease involving v
arying severity of ins*lin deficiency
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Discussion 8atients (it) DKA mostly )ave type , diabetes mellit*
s6 ()ic) is associated (it) absol*te ins*lin deficiency#Ho(ever6 patients (it) advanced or severe type 2 dia
betes can also be at ris7
HH. occ*rs almost e4cl*sively in type 2 diabetes mell
it*s6 ()o contin*e to demonstrate some degree of ins*lin secretion
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Discussion
DKA and HH. )ave differing diagnostic criteria6 b*tn*mero*s individ*als )ave overlapping feat*res
ffective osmolality 2 4 a & l*cose / ,-
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Discussion
nitial eval*ation of )yperglycemic emergency s)o*ld incl*de a s*rvey of etiology
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Differential diagnosis
*mero*s conditions may mimic DKA and HH.
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21/22
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22/22