Vol 7, No 1 (2022)
Case report
Published online: 2022-03-18

open access

Page views 4980
Article views/downloads 464
Get Citation

Connect on Social Media

Connect on Social Media

Severe hypertriglyceridemia in the course of ketoacidosis in a patient with newly diagnosed type 1 diabetes mellitus

Eliza Skala-Zamorowska1, Halla Kaminska12, Wladyslaw Gawel32, Lukasz Szarpak42, Wojciech Mlynarski5, Przemyslawa Jarosz-Chobot1
Disaster Emerg Med J 2022;7(1):58-62.

Abstract

BACKGROUND: One of the most serious complications in delayed diagnosis of DKA is hypertriglyceridemia (HTG), Prevalence of mild hypertriglyceridemia is found in about 50% of patients with diabetic ketoacidosis (DKA). Prevalence of severe hypertriglyceridemia [TG > 22.4 mmol/L (> 1959 mg/dL)] was found in about 1–8% of adults with DKA, but few data have been reported in children with severity ranging from asymptomatic to severe acute pancreatitis.
CASE PRESENTATION: A 2-year-old-girl with a 2 weeks history of generalized weakness, polydipsia, polyuria, and vulvar candidiasis was admitted to the Intensive Care Unit with clinical signs of DKA. Our patient was met the diagnostic criteria for DKA (pH 7.1, HCO3- 8.8 mmol/L, BE -21.1 mmol/L), glucose level of > 22 mmol/L (556 mg/dl). Initial biochemical analysis showed hyperlipidemia [TG 11470 mg/dL (131.1 mmol/L)], amylase 28 U/L. Her blood demonstrated a grossly lipemic appearance and her lipemic condition disturbed the results of other biochemical blood investigations. The objective of this case report is to present and describe the clinical features, laboratory investigations, case management, and natural course of hypertriglyceridemia in a 2-year-old girl with DKA.
CONCLUSIONS: Lipemia secondary to severe HTG may exist in new-onset T1DM with DKA. Diabetic lipemia can be caused not only by profound insulin deficiency. An additional factor which should be taken into consideration in very young children is breastfeeding, which is associated with increased mean total cholesterol (TC) and LDL levels. Moreover, severe hypertriglyceridemia may result in mutations of genes encoding lipoprotein lipase (LPL).

Article available in PDF format

View PDF Download PDF file

References

  1. Saengkaew T, Sahakitrungruang T, Wacharasindhu S, et al. DKA with Severe Hypertriglyceridemia and Cerebral Edema in an Adolescent Boy: A Case Study and Review of the Literature. Case Rep Endocrinol. 2016; 2016: 7515721.
  2. Wolfgram PM, Macdonald MJ. Severe Hypertriglyceridemia Causing Acute Pancreatitis in a Child with New Onset Type I Diabetes Mellitus Presenting in Ketoacidosis. J Pediatr Intensive Care. 2013; 2(2): 77–80.
  3. Hahn SJ, Park Jh, Lee JHo, et al. Severe hypertriglyceridemia in diabetic ketoacidosis accompanied by acute pancreatitis: case report. J Korean Med Sci. 2010; 25(9): 1375–1378.
  4. Karagianni C, Stabouli S, Roumeliotou K, et al. Severe hypertriglyceridaemia in diabetic ketoacidosis: clinical and genetic study. Diabet Med. 2004; 21(4): 380–382.
  5. Radhakutty A, Shen J, Hooper AJ, et al. Quantification and genotyping of lipoprotein lipase in patients with diabetic lipaemia. Diabet Med. 2014; 31(12): 1702–1707.
  6. Aboulhosn K, Arnason T. Acute pancreatitis and severe hypertriglyceridaemia masking unsuspected underlying diabetic ketoacidosis. BMJ Case Rep. 2013; 2013.
  7. Fulop M, Eder H. Severe hypertriglyceridemia in diabetic ketosis. Am J Med Sci. 1990; 300(6): 361–365.
  8. Fulop M, Eder HA. Plasma triglycerides and cholesterol in diabetic ketosis. Arch Intern Med. 1989; 149(9): 1997–2002.
  9. McLean AG, Petersons CJ, Hooper AJ, et al. Extreme diabetic lipaemia associated with a novel lipoprotein lipase gene mutation. Clin Chim Acta. 2009; 406(1-2): 167–169.
  10. 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(10): 2795–2800.
  11. Blackett PR, Holcombe JH, Alaupovic P, et al. Plasma lipids and apolipoproteins in a 13-year-old boy with diabetic ketoacidosis and extreme hyperlipidemia. Am J Med Sci. 1986; 291(5): 342–346.
  12. Harit D, Faridi MMA, Aggarwal A, et al. Lipid profile of term infants on exclusive breastfeeding and mixed feeding: a comparative study. Eur J Clin Nutr. 2008; 62(2): 203–209.
  13. Thorsdottir I, Gunnarsdottir I, Palsson GI. Birth weight, growth and feeding in infancy: relation to serum lipid concentration in 12-month-old infants. Eur J Clin Nutr. 2003; 57(11): 1479–1485.