Endocrinol Metab.  2012 Mar;27(1):89-92. 10.3803/EnM.2012.27.1.89.

Ketoacidosis with Hypertriglyceridemia-Induced Pancreatitis in a Patient with Gestational Diabetes: A Case Report

• Chung HH
• Park SH
• Yoon JS
• Won KC
• Lee HW

• KMID: 2134825
• DOI: http://doi.org/10.3803/EnM.2012.27.1.89

Abstract

Hypertriglyceridemia-induced acute pancreatitis in pregnancy is not a common complication. Moreover, ketoacidosis in gestational diabetes occurs rarely. Here we report a case of ketoacidosis with hypertriglyceridemia-induced pancreatitis in a patient with gestational diabetes that was successfully treated with insulin and supportive care. In this case, a 36-year-old woman (at 32 weeks' gestation) was diagnosed with gestational diabetes 4 weeks prior, but did not have well controlled blood sugar. She complained of severe epigastric pain concomitant with nausea and vomiting. Radiology and laboratory tests found hypertriglyceridemia (1,996 mg/dL), acute pancreatitis, and ketoacidosis with absence of fetal deceleration on a non-stress test. The patient's condition improved with insulin therapy and fluid replacement. To our knowledge, this is the first report of a case of ketoacidosis with hypertriglyceridemia-induced pancreatitis in a patient with gestational diabetes.

Keyword

Acute pancreatitis; Gestational diabetes; Hypertriglyceridemia

MeSH Terms

Adult
Blood Glucose
Deceleration
Diabetes, Gestational
Female
Humans
Hypertriglyceridemia
Insulin
Ketosis
Nausea
Pancreatitis
Pregnancy
Vomiting
Blood Glucose
Insulin

Figure

• 

  Fig. 1 A. Ultrasonographic finding in abdomen. Visible pancreas showed edematous change with surrounding fat infiltration; this is suggestive of acute pancreatitis. B. This shows a mildly improved state of A B acute pancreatitis.

Reference

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

2. Toskes PP. Hyperlipidemic pancreatitis. Gastroenterol Clin North Am. 1990. 19:783–791.

3. Chang CC, Hsieh YY, Tsai HD, Yang TC, Yeh LS, Hsu TY. Acute pancreatitis in pregnancy. Zhonghua Yi Xue Za Zhi (Taipei). 1998. 61:85–92.

4. Crisan LS, Steidl ET, Rivera-Alsina ME. Acute hyperlipidemic pancreatitis in pregnancy. Am J Obstet Gynecol. 2008. 198:e57–e59.

5. Roberts IM. Hyperlipidemic gestational pancreatitis. Gastroenterology. 1993. 104:1560–1562.

6. De Chalain TM, Michell WL, Berger GM. Hyperlipidemia, pregnancy and pancreatitis. Surg Gynecol Obstet. 1988. 167:469–473.

7. Sanderson SL, Iverius PH, Wilson DE. Successful hyperlipemic pregnancy. JAMA. 1991. 265:1858–1860.

8. Bedalov A, Balasubramanyam A. Glucocorticoid-induced ketoacidosis in gestational diabetes: sequela of the acute treatment of preterm labor. A case report. Diabetes Care. 1997. 20:922–924.

9. Maislos M, Harman-Bohem I, Weitzman S. Diabetic ketoacidosis. A rare complication of gestational diabetes. Diabetes Care. 1992. 15:968–970.

10. Bernstein IM, Catalano PM. Ketoacidosis in pregnancy associated with the parenteral administration of terbutaline and betamethasone. A case report. J Reprod Med. 1990. 35:818–820.

11. Montelongo A, Lasunción MA, Pallardo LF, Herrera E. Longitudinal study of plasma lipoproteins and hormones during pregnancy in normal and diabetic women. Diabetes. 1992. 41:1651–1659.

12. Rizzo M, Berneis K, Altinova AE, Toruner FB, Akturk M, Ayvaz G, Rini GB, Spinas GA, Arslan M. Atherogenic lipoprotein phenotype and LDL size and subclasses in women with gestational diabetes. Diabet Med. 2008. 25:1406–1411.

13. Herrera E, Amusquivar E, López-Soldado I, Ortega H. Maternal lipid metabolism and placental lipid transfer. Horm Res. 2006. 65:Suppl 3. 59–64.

14. Howard JM, Reed J. Pseudohyponatremia in acute hyperlipemic pancreatitis. A potential pitfall in therapy. Arch Surg. 1985. 120:1053–1055.

15. McKay AJ, O'Neill J, Imrie CW. Pancreatitis, pregnancy and gallstones. Br J Obstet Gynaecol. 1980. 87:47–50.

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

17. Chang YT, Chang MC, Su TC, Liang PC, Su YN, Kuo CH, Wei SC, Wong JM. Association of cystic fibrosis transmembrane conductance regulator (CFTR) mutation/variant/haplotype and tumor necrosis factor (TNF) promoter polymorphism in hyperlipidemic pancreatitis. Clin Chem. 2008. 54:131–138.

18. 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.

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

20. 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.