Gestational pancreatitis complicating uncontrolled diabetes mellitus

A 36-year-old G5 P2AB2 woman was admitted to our hospital due to nausea, vomiting and severe epigastric pain for one day at 24 weeks gestation. She had a history of diabetes for one year, but was not receiving any medical treatment. The patient also denied any other drug history or alcohol drinking. Physical examination revealed a blood pressure of 150/100 mmHg, body temperature 37°C, weight 60 kg, and height 159 cm. Cutaneous eruptions or xanthomas were not seen. The epigastric tenderness was severe, but without rebounding pain or muscle rigidity. Pelvic examination was unremarkable. Fundus height was 22 cm and foetal heart rate 140 beats/min. Laboratory studies showed a serum amylase level of 457 U/l (normal range <180 U/l) and lipase 1056 U/l (<190 U/l). Plasma sugar was 12.9 mmol/l, triglycerides 81.8 mmol/l and total cholesterol 20.7 mmol/l. HbA1c was 10.2% (4–6%), and postprandial serum C-peptide 0.2 nmol/l. Arterial blood gasses were pHa 7.23, paO2 113 mmHg at room air, paCO2 21 mmHg, base deficit …