J Korean Med Sci.  2010 Sep;25(9):1375-1378. 10.3346/jkms.2010.25.9.1375.

Severe Hypertriglyceridemia in Diabetic Ketoacidosis Accompanied by Acute Pancreatitis: Case Report

• Hahn SJ
• Park JH
• Lee JH
• Lee JK
• Kim KA

• KMID: 1785921
• DOI: http://doi.org/10.3346/jkms.2010.25.9.1375

Abstract

We report a case of diabetic ketoacidosis (DKA) and hypertriglyceridemia (severely elevated to 15,240 mg/dL) complicated by acute pancreatitis, which was treated successfully with insulin therapy and conservative management. A 20-yr-old woman with a history of type 1 diabetes came to the emergency department 7 months after discontinuing insulin therapy. DKA, severe hypertriglyceridemia and acute pancreatitis were diagnosed, with DKA suspected of contributing to the development of the other conditions. In Korea, two cases of DKA-induced hypertriglyceridemia and 13 cases of hypertriglyceridemia-induced acute pancreatitis have been previously reported separately.

Keyword

Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Hypertriglyceridemia; Acute Pancreatitis

MeSH Terms

Acute Disease
Diabetes Mellitus, Type 1/complications/diagnosis/therapy
Diabetic Ketoacidosis/complications/*diagnosis/therapy
Female
Humans
Hypertriglyceridemia/complications/*diagnosis/therapy
Insulin/therapeutic use
Pancreatitis/complications/*diagnosis
Tomography, X-Ray Computed
Young Adult

Figure

• 

  Fig. 1 Photograph of hyperlipidemic serum extracted by centrifugation from the patient's blood sample.

• 

  Fig. 2 Contrast-enhanced pancreas CT scan (arterial phase). Initial pancreas CT scan shows diffuse swelling of pancreas body, tail, demonstrating CT grade D acute pancreatitis with peripancreatic fat infiltration (arrow), fluid collection suggesting inflammation (A) and edematous change of pancreatic head (openarrow) (B).

Reference

1. Kitabchi AE, Nyenwe EA. Hyperglycemic crises in diabetes mellitus: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Endocrinol Metab Clin North Am. 2006. 35:725–751.

2. Chiasson JL, Aris-Jilwan N, Belanger R, Bertrand S, Beauregard H, Ekoe JM, Fournier H, Havrankova J. Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state. CMAJ. 2003. 168:859–866.

3. Kitabchi AE, Umpierrez GE, Murphy MB, Barrett EJ, Kreisberg RA, Malone JI, Wall BM. Hyperglycemic crises in diabetes. Diabetes Care. 2004. 27:Suppl 1. S94–S102.

4. Exton JH. Mechanisms of hormonal regulation of hepatic glucose metabolism. Diabetes Metab Rev. 1987. 3:163–183.

5. Fortson MR, Freedman SN, Webster PD 3rd. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol. 1995. 90:2134–2139.

6. Choi DS, Oh JH, Park IB, Kim JW, Choi KM, Kim YH, Kim NH, Kim SJ, Baik SH. A case of severe hypertriglyceridemia with diabetic ketoacidosis. J Korean Diabetes Assoc. 1999. 23:715–721.

7. Choi SH, Sohn TS, Lee JI, Kim ES, Choi WH, Shin J, Son HS. A case of severe hypertriglyceridemia in diabetic ketoacidosis. Korean Clin Diabetes. 2008. 9:336–340.

8. Fulop M, Eder H. Severe hypertriglyceridemia in diabetic ketosis. Am J Med Sci. 1990. 300:361–365.

9. Fulop M, Eder HA. Plasma triglycerides and cholesterol in diabetic ketosis. Arch Intern Med. 1989. 149:1997–2002.

10. Karagianni C, Stabouli S, Roumeliotou K, Traeger-Synodinos J, Kavazarakis E, Gourgiotis D, Lambrou J, Kanavakis E. Severe hypertriglyceridaemia in diabetic ketoacidosis: clinical and genetic study. Diabet Med. 2004. 21:380–382.

11. Frier BM, Steer CR, Baird JD, Bloomfield S. Misleading plasma electrolytes in diabetic children with severe hyperlipidaemia. Arch Dis Child. 1980. 55:771–775.

12. Havel RJ. Pathogenesis, differentiation and management of hypertriglyceridemia. Adv Intern Med. 1969. 15:117–154.

13. Havel RJ. Approach to the patient with hyperlipidemia. Med Clin North Am. 1982. 66:319–333.

14. Tsuang W, Navaneethan U, Ruiz L, Palascak JB, Gelrud A. Hypertriglyceridemic pancreatitis: presentation and management. Am J Gastroenterol. 2009. 104:984–991.

15. Yadav D, Pitchumoni CS. Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol. 2003. 36:54–62.

16. Nair S, Yadav D, Pitchumoni CS. Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA. Am J Gastroenterol. 2000. 95:2795–2800.

17. Yadav D, Nair S, Norkus EP, Pitchumoni CS. Nonspecific hyperamylasemia and hyperlipasemia in diabetic ketoacidosis: incidence and correlation with biochemical abnormalities. Am J Gastroenterol. 2000. 95:3123–3128.

18. Furuya T, Komatsu M, Takahashi K, Hashimoto N, Hashizume T, Wajima N, Kubota M, Itoh S, Soeno T, Suzuki K, Enzan K, Matsuo S. Plasma exchange for hypertriglyceridemic acute necrotizing pancreatitis: report of two cases. Ther Apher. 2002. 6:454–458.

19. Huang DB, Raskin P. Diabetic hypertriglyceridemia-induced acute pancreatitis masquerading as biliary pancreatitis. J Diabetes Complications. 2002. 16:180–182.

20. Lee CY, Lee MK, Lee SY, Hong SN, Kim HH, Kang BH, Kang HW, Lee BW, Park YJ, Min YK, Lee MS, Kim KW, Kim JH. A case of acromegaly with diabetic detoacidosis and hypertriglyceridemia-induced acute pancreatitis. J Korean Soc Endocrinol. 2002. 17:110–116.