Endocrine Abstracts

Introduction: Although it is recognised that diabetic ketoacidosis may present with abdominal pain, it remains important to exclude an underlying acute pancreatitis which may be masked due to ambiguous presentation.

Case: A 23-year old woman with a history of type 2 diabetes and non-compliance for her oral antidiabetic medication presented to the emergency department with abdominal epigastric pain and nausea starting a few hours before admission. Laboratory examination revealed a mild ketoacidosis while an abdominal CT scan performed the following day demonstrated a severe acute pancreatitis of the body and tail (Balthazar Grade E) despite normal amylase serum levels upon admission, the absence of inflammatory signs and the presence of only mild clinical symptoms. The presence of a lactescent serum was the clue to an extremely high triglyceride level (>10 000 mg/dl) causing the pancreatitis. The hypertriglyceridemia itself was attributed mainly to the diabetic ketoacidosis. There was no family history of hypertriglyceridemia. Treatment with i.v. insulin and hydration successfully resolved the ketoacidosis and hypertriglyceridemia and reversed the episode of acute pancreatitis.

Conclusion: The triad consisting of diabetic ketoacidosis, hypertriglyceridemia and acute pancreatitis is an unusual presentation of poorly controlled diabetes which can occur in type 1 as well as type 2 diabetic adults and children. With this unusual case we emphasize the need to perform an abdominal CT scan in case of persistent abdominal pain in ketoacidosis, especially in the presence of an hyperlipidaemic serum, which can cause falsely low or normal amylase and lipase levels despite an acute pancreatitis.