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More on the Triad of Pancreatitis, Hyperamylasemia, and Hyperglycemia

Alexander Haubenstock, MD; Karl Hruby, MD; Ulrich Jäger, MD
JAMA. 1983;249(12):1563. doi:10.1001/jama.1983.03330360017009.
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To the Editor.—  We read in the QUESTIONS AND ANSWERS section (1982; 248:1754) the case report concerning a 63-year-old patient with abdominal pain who appeared lethargic and disoriented and in whom physical and laboratory findings were consistent with a diagnosis of acute pancreatitis, including hyperamylasemia, hyperglycemia, and ketoacidosis. The patient was treated with vigorous rehydration and intravenous as well as subcutaneous insulin. After one episode of hypoglycemia, use of insulin was discontinued. The patient recovered completely.This problem was discussed by an internist and an endocrinologist, and both concluded that an episode of acute pancreatitis with a background of alcoholism was the most likely explanation, although Dr Frawley raised the interesting question of whether acute pancreatitis was indeed present. Although we agree with the conclusions reached, we think that—on the basis of the facts provided—the toxicologist's point of view might be of interest as well.Anticholinesterase agents, eg, in the

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