Endocrine Abstracts

Diabetic ketoacidosis (DKA) is a state of absolute or relative insulin deficiency characterized by hyperglycemia, metabolic acidosis and ketosis and occurs mainly in type 1 diabetes mellitus (DM). While enhanced lipolysis and inhibition of lipoprotein lipase in DKA lead to typically not severe elevation of triglyceride (TG) level, extreme hypertriglyceridemia (HTG) is rarely seen. If complicated with acute pancreatitis (AP), DKA and HTG form a scarcely reported triad, controversial regarding pathophysiology and possible sequence of events. We report a case of a 35-years-old obese male, non-smoker, admitted to the hospital through the emergency department because of a worsening, sharp pain in upper abdomen associated with high fever, anorexia, nausea and vomiting. His past medical history included dyslipidemia diagnozed 2 years ago (shortly on statins) and cholecystectomy 9 years ago. He denied any alcohol consumption. On physical examination, he was concious, dehydrated, dyspneic and normotensive, with mildly tender abdomen in epigastric region. Laboratory findings revealed blood glucose of 24.6 mmol/l with metabolic acidosis and positive ketones in urine. His serum was milky and turbid, which suggested severe HTG: measured TG level was 110 mmol/l. Serum amilase and lipase levels were 878 and 1862 IU/I respectively. A contrast-enhanced computed tomography of the abdomen confirmed the diagnosis of AP. Upon admission, DKA and AP were successfully treated by insulin infusion, intravenous hydratation, potassium supplementation and analgesics. Additional analysis showed normal level of C-peptide, glycated hemoglobin (HbA1c) of 13.4% and negative immunology for type 1 DM which supported the diagnosis of DKA as initial manifestation of type 2 DM (T2DM). The reported case of DKA in adult with previously undiagnosed T2DM accompanied with severe HTG and AP demonstrates a significance of multidisciplinary approach concerning a challenging prompt diagnosis, treatment modalities and consequent follow-up after hospital discharge.