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Pancreatitis in T1DM — RACP Adult Medicine MCQ

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ModerateGeneral Internal MedicinePancreatitis in T1DMRACP Adult Medicine

A 42-year-old man with type 1 diabetes presents with a 4-day history of progressive abdominal pain, nausea, and vomiting. His blood glucose is 14 mmol/L, pH 7.32, HCO₃ 18 mmol/L, ketones 2.5 mmol/L, and lipase is 1500 U/L. CT abdomen shows peripancreatic fat stranding. What is the most likely diagnosis?

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Correct answer: D — Acute pancreatitis with mild metabolic derangement

This patient has acute pancreatitis (markedly elevated lipase, CT findings) with mild metabolic acidosis and ketonaemia that is likely a consequence of fasting/vomiting and insulin deficiency rather than full-blown DKA. The mild ketonaemia (2.5 mmol/L) with only mildly reduced bicarbonate distinguishes this from severe DKA. Management priorities are acute pancreatitis management (aggressive IV fluids, analgesia, anti-emetics) plus insulin adjustment. If ketones worsen, a DKA protocol should be commenced concurrently.

Reference: eTG – 2025 – Gastrointestinal; ADS – 2023 – DKA Management