Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA

Where does serum amylase come from and where does it go

Renal clearance of amylase from the blood, expressed as a proportion of simultaneous creatinine clearance, is consistent within a narrow range (3.1 per cent ± 1.1 [S.D.]) in normal persons. In patients with acute pancreatitis the amylase/creatinine clearance ratio rises regularly and significantly (9.8 ± 3.5, p < 0.001). Only three of 42 patients with acute pancreatitis had a clearance ratio below 5.3 per cent. In contrast, the amylase/creatinine clearance ratio remained within the normal range in 44 patients with hyperamylasemia due to disease other than pancreatitis. This observation suggests that renal permeability to amylase is altered in acute pancreatitis, and provides a basis for using the amylase/creatinine clearance ratio in the differential diagnosis of hyperamylasemia. (N Engl J Med 292:325–328, 1975)

https://www.nejm.org/doi/pdf/10.1056/NEJM197502132920701?listPDF=true

Specificity of Increased Renal Clearance of Amylase in Diagnosis of Acute Pancreatitis

Nonspecific hyperamylasemia and hyperlipasemia in diabetic ketoacidosis: incidence and correlation with biochemical abnormalities.

All 78 patients with acute pancreatitis admitted to one hospital in a 2-year period were included in a prospective survey of conservative management. The overall mortality rate was 11.5 per cent, being 46 per cent for 11 patients subjected to early laparotomy and only 6 per cent for patients managed without operation. Twenty-six patients were considered to have severe acute pancreatitis and all 9 deaths occurred in this group.



Biliary disease was present in 51 per cent of patients, and the majority of those with biliary disease were over 60 years old. Alcohol-related acute pancreatitis occurred in 26 per cent of the total patients, and none of this group was over 60 years old. Acute pancreatitis was considered idiopathic in origin in only 13 per cent of the patients.



Elective biliary surgery in 30 patients has resulted in freedom from recurrent attacks of acute pancreatitis for the follow-up period (12–30 months).



The results compare favourably with those in which glucagon and high dosage aprotinin (Trasylol) have been utilized in the management of acute pancreatitis.

A prospective study of acute pancreatitis.

The renal handling of amylase was studied in patients with renal insufficiency, acute pancreatitis, and macroamylasemia by measuring the rate of amylase clearance (CAm) relative to the rat...

The Renal Clearance of Amylase in Renal Insufficiency, Acute Pancreatitis, and Macroamylasemia

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The Renal Clearance of Amylase in Renal Insufficiency, Acute Pancreatitis, and Macroamylasemia