Abdominal pain in hyperglycemia

Q: Abdominal pain is more common in? (select one)

A) Diabetic ketoacidosis (DKA)

B) Hyperosmolar hyperglycemic state (HHS)

Answer: A

Abdominal pain in a hyperglycemic state is equivalent to DKA, proving otherwise. It's very rare in HHS. Although abdominal pain in DKA is more common in children simultaneously, it is not uncommon in adults. 

Abdominal pain in DKA has a prognostic value as it correlates with the severity of metabolic acidosis. In fact, it is universal when serum bicarbonate falls below ≤5 mEq/L. Said that abdominal pain has shown no correlation with the severity of hyperglycemia or dehydration.

The cause of abdominal pain in DKA is delayed gastric emptying and ileus due to metabolic acidosis and electrolyte abnormalities. Pancreatitis needs to be ruled out, particularly if pain persists after the resolution of ketoacidosis.

#endocrinology

References:

1. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009 Jul;32(7):1335-43. doi: 10.2337/dc09-9032. PMID: 19564476; PMCID: PMC2699725.

2. Malone ML, Gennis V, Goodwin JS. Characteristics of diabetic ketoacidosis in older versus younger adults. J Am Geriatr Soc 1992; 40:1100.

3. Umpierrez G, Freire AX. Abdominal pain in patients with hyperglycemic crises. J Crit Care. 2002 Mar;17(1):63-7. doi: 10.1053/jcrc.2002.33030. PMID: 12040551.