Endocrine Abstracts

Introduction: Diabetic ketoacidosis (DKA) is a complication of insulin deficiency and can rarely be associated with diabetic lipemia, which is a life threatening condition.

Case report: We report a 20-year-old male, who visited emergency department with a short history of abdominal pain and vomiting. Clinically he was alert, had kussmaul’s breathing, and was found to be hyperglycaemic, with metabolic acidosis and ketonemia (RBS 18, Ph 7.18 HCO3 8.4). His venous blood appeared grossly lipemic (Triglyceride 35 mmol/l). Amylase was normal. His DKA was treated in accordance with the British Joint society of Diabetes guidelines. The initial management dilemma we faced were laboratory interference due to hyperlipidaemia that lead to a delay in resolution of DKA. His diabetes autoantibodies were detected, however, Lipoprotein lipase genetic testing was not done as it is not available in our region. His lipids normalised on follow up.

Discussion: In DKA, insulin deficiency activates lipolysis in the adipose tissue releasing free fatty acids, which accelerates formation of VLDL, together with reduced lipoprotein lipase activity results in hypertriglyceridemia. Evaluation of electrolytes are pivotal in the management of DKA due to the rapid infusion of insulin and fluids. As seen in our case, lipemic samples cause analytical errors and pose challenges to fluid management and electrolyte replacement in the management of DKA, due to the difficulties in analysis, especially those without ultracentrifuges. In such circumstances, emphasis should be placed on clinical evaluation followed by hydration and insulin administration which assists in the resolution of DKA and eventually lipemia. If available, the use of high speed micro centrifuges showed effectivity in reducing lipid levels provided a suitable alternative to ultra-centrifuges.

Conclusion: Severe hyperlipidaemia causing lipemic serum in patients with DKA is rare phenomenon, and clinicians should consider devastating consequences such as acute pancreatitis or lipemic retinalis, thus prompt insulin administration is pivotal.