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eNecr otizi
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eati
ti
sinducedbySever
e
Hypert
rigl
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adofMetabol
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ders
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athi
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ari
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,Vanyi
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at,Kot
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Int roduct i
on gass incetwo day sbef oreadmi s- Onday3,hes t ills howeds ignof
Acut ePancr eati
tis( AP)hast obe s i
on. Hehasahi storyofheav yalco- i l eus ,t hus CECT was t ak en.I t
inv est
igat ed when encount er ng holcons
i umpt i
on. s howednecr ot iz at ionoft hehead
ofpancr easandflui dcol lect ioni n
di abetic k etoacidos is ( DKA) . He appear ed del ir
ious,wi th ex-
t heper ipancr eat icr egi on.
Sy mpt omsofDKA maymas kAP ,t r
emes inustachy cardia,fever
,and
He wascons ul t ed t o adi ges tiv e
hence del aying t he t r eatment . had Kus smaulbr eathing. Abdo-
me n was di
s t
en ded w i
th decreas
e d s ur geonandl apar ot omywascon-
About11% ofDKAcas ecoi ncide duct ed f ordebr idementand ne-
wi thAP . bowels ound,and t endernessi n
the epigast
rica r
ea . cr os ect omy .Hewasabl et o pas s
Ar ound1- 4% cas esofAPar eel ic- gasand i mmedi at el ys tar ted on
ited by hy per t
riglycer i
demi a DK A w asco nfirme d by high bl
oo d Arrow poi nted nec r
oti
zati
on oft he
headoft hepanc r
eas ent er aldi et .Medi cat ion was t a-
(HTG) . Thel evel ofTGabov e1000 gl ucose, k etonemi a, and hi gh
per edt oor al .Hewasdi s char ged
mg/ dLi sas sociated wi ths i
gni fi- aniongapmet abolicacidosis. APwasconfir medwi t
helevat i
onof wi t hor alfibr at e,ant i
di abet ic,and
cantr isk. l
ipas e. The fir s t blood s ampl e ant i coagul antmedi cat ion.
Pat hophy s i
ologi cr oles bet ween drawnwasl ipemi cand unabl et o
bepr oces sed, hehadt obef ast
Concl
ed. APcaneas
us ion
AP- DKA- HTG i ss ti
lluncl ear.Inpa- ilybeunder di agnos ed
tientmor talit
y and mor bidit
yi s Later ,i t was ex plai
ned by t he i nt hecas eofDKA.HTG i sanun-
significant lyhi gherwi t
ht het riad. sev ereHTG.Renaland l i
verf unc- commonet iol ogyofAPy etpos s i-
ti
onr emai nednor mal.
Cas eDes cr i
pt ion Abdomi nalx -r
ays howed gas tri
c
bl e. Met icul ousdi agnos ti candag-
Pat i
enti sa34y earsol dNi ger i
an gr es iv et r eat mentunt il s ur gi cal de-
dilation,nos ignofpneumoper it
o-
manwi thi ns i
diousons etofepi - br i dementmaybeneces sar
neum.He was puton NPO,r e- References:
gas tr
icpai nr adiatingt ot heback, ceiv edflui dr escuci t
ati
on,cont inu- 1tr.iaSdimo ns
ofdi
-Linar
abet
esCR,
esket
J
angS,
oacidosi
s
SanakaM,
,hypertr
igl
Bhat
ycer
i
tA,L
demi
opezR,
aandac
Var
goJ
ut
,
etal
epancr
.
eat
The
i
ti
s.How

accompani edwi thf ever,naus ea, ousI Vinsulinandhepar indrip,and dInopeastiietnatffSeacmp

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