Introduction

Diabetic crises occur most often in patients with type 1 diabetes and occasionally in type 2 diabetes, especially under stressful conditions. However, a diabetic crisis occurring directly from prediabetes is an unusual phenomenon.

Case Report

A 45-year-old woman presented with postprandial left upper quadrant abdominal pain, nausea, and vomiting. She had a past medical history of prediabetes with impaired fasting glucose and HbA1c 6.4%. On admission, routine laboratory tests showed high anion gap metabolic acidosis (pH 6.92), anion gap 41 mmol/L, blood glucose 931 mg/dL, beta-hydroxybutyrate 28 mmol/L, and calculated effective osmolarity 322 mOsm/kg; she was diagnosed with diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS), and DKA-related abdominal pain. Later, the patient was found to have elevated lipase and amylase, and diagnosed with acute pancreatitis. Since DKA can induce abdominal pain and nonspecific lipase elevation, both of which are characteristics of acute pancreatitis, while acute pancreatitis can conversely trigger DKA, there exists a “chicken and egg” paradigm. Therefore, the differential diagnosis is discussed.

Conclusion

It is important to differentiate DKA from concomitant causes of abdominal pain to avoid missing the underlying etiology, which can be the trigger for DKA. During diabetic crises, treating the underlying trigger is just as important as managing metabolic derangements in order to achieve favorable outcomes; meanwhile, managing acute pancreatitis-associated hyperglycemia can promote recovery. Additionally, diabetic crisis that directly evolves from prediabetes illustrates an atypical form of diabetes called ketosis-prone diabetes; we briefly discuss its clinical characteristics, classification, and follow-up.

中文翻译：

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前驱糖尿病直接恶化为由急性胰腺炎引发的糖尿病酮症酸中毒和高渗性高血糖综合症：一例病例报告，阐明了酮症-酮型糖尿病的“鸡和蛋”范式。

介绍

糖尿病危机最常发生于1型糖尿病患者，偶发于2型糖尿病，特别是在压力条件下。但是，直接来自糖尿病前期的糖尿病危机是不寻常的现象。

案例报告

一名45岁的女性出现餐后左上腹腹痛，恶心和呕吐。她有空腹血糖受损和HbA1c 6.4％受损的糖尿病前期病史。入院时常规实验室检查显示高阴离子间隙代谢酸中毒（pH 6.92），阴离子间隙41 mmol / L，血糖931 mg / dL，β-羟基丁酸酯28 mmol / L，计算的有效摩尔渗透压浓度为322 mOsm / kg。她被诊断出患有糖尿病酮症酸中毒（DKA）和高渗性高血糖综合征（HHS），以及DKA相关的腹痛。后来，该患者被发现脂肪酶和淀粉酶升高，并被诊断出患有急性胰腺炎。由于DKA可以诱发腹痛和非特异性脂肪酶升高，这都是急性胰腺炎的特征，而急性胰腺炎则可以触发DKA，存在“鸡和蛋”的范例。因此，讨论了鉴别诊断。

结论

重要的是将DKA与伴随的腹痛原因区分开，以避免遗漏潜在的病因，而病因可能是DKA的触发因素。在糖尿病危机中，治疗潜在的触发因素与控制代谢紊乱以达到理想的结果一样重要。同时，处理急性胰腺炎相关的高血糖可以促进恢复。此外，直接从糖尿病前期发展而来的糖尿病危机说明了一种非典型的糖尿病形式，即易患酮症的糖尿病。我们简要讨论其临床特征，分类和随访。