A 61-year-old woman was referred from a regional hospital for acute renal failure.
The patient reported severe diarrhea and vomiting for a week.
Her medical history included hypertension and diabetes mellitus treated with irbesartan, amlodipine and metformin (850 mg/12 h).
The physical examination revealed intense whitening, tachypnea and syncope, although the patient responded to orders.
The abdomen was blushing and painless.
Blood pressure was 90/40 mmHg, heart rate was 70 beats/minute and temperature was 35.8o C. Table 2 shows the main analytical data.
Serum amylase was 94 U/l.
Fluid intake normalized blood pressure and administration of 165 mEq of bicarbonate raised pH to 7.06 and bicarbonate to 4 mEq/l.
The patient underwent an urgent hemodialysis session and treatment with metformin was discontinued.
Twelve hours after admission creatinine was 2.2 mg/dl and pH 7.43, but amylase increased to 1319 U/l, with normal ionized calcium and triglycerides.
An abdominal computed tomography revealed a peripancreatic fat mass consistent with acute pancreatitis.
No known causes of pancreatitis were found, including hypertriglyceridemia, hypercalcemia, alcoholism, biliary lithiasis or trauma.
The patient had a favorable evolution and was admitted to the ward 72 hours later.
