Acute Kidney Injury Masquerading as Acute Pancreatitis - Role of Serum Amylase and Lipase in Patients with Blunt Abdominal Trauma

Blunt trauma to abdomen is one of the common causes for morbidity and mortality. In blunt abdominal trauma, there may be trauma to the pancreas, tear of bowel and hollow viscous, which can result in elevated levels of serum amylase and lipase. Serum amylase and mainly serum lipase are diagnostic markers for pancreatitis according to some literature. We report a young male, who presented with complaints of acute abdominal pain, constipation and vomiting after blunt abdominal trauma with elevated serum amylase and lipase levels with normal pancreas. Initial assessment of intra-abdominal pathology due to blunt abdominal trauma is often challenging as many injuries may not manifest during the treatment period. The manifestations may vary from being simply asymptomatic to life threatening injuries due to unavailability of accurate information about the nature of trauma. Hence, accurate diagnosis becomes very important in the management. Injury to the pancreas is not common and can result from direct penetration or through the transmission of blunt force to the retroperitoneum. Some studies report an incidence of 0.2 % cases for blunt trauma up to 1.1 % cases for penetrating trauma.1 The role of ultrasonography (USG) and Computed Tomography (CT) in management of Blunt abdominal trauma is well established. But the role of laboratory tests in the evaluation of these patients is controversial.2 In cases of Blunt trauma to abdomen, lot of causes found to cause serum amylase and serum lipase levels tend to raise. Some of these causes can be pancreatic, rupture of hollow viscus or bowel, facial and brain injury.3 It has also been found that reduced clearance of lipase can be caused by renal impairment. Thus non‐pathological raise in level of pancreatic enzymes, and other miscellaneous causes such as diabetes mellitus, drugs and infections shall be included as alternative pancreatic diagnoses.3

Acute Emamectin Benzoate Poisoning- A Fatal Case Report.

Emamectin benzoate is a broad-spectrum insecticide for vegetables having wide margin of safety as reported in animal studies, due to its low gamma-aminobutyric acid receptor affinities and very poor penetration to the blood-brain barrier. Not a single case has been reported about fatal human exposure in India. This case highlights about 40-year-old man who succumbed in intensive care unit even after all supportive treatment as well as with Flumazenil and Lipid emulsion. Emamectin benzoate is a semisynthetic avermectin, a class of natural fermentation products of Streptomyces avermitilis (soil microorganism).