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Triad of Diabetic Ketoacidosis, Hypertriglyceridemia, and Acute Pancreatitis: Severity of Acute Pancreatitis May Correlate with the Level of Hypertriglyceridemia.
Cureus. 2019 Jun 18; 11(6):e4930.C

Abstract

A 50-year-old African-American male with no known previous medical comorbidities presented to the emergency room with complaints of three days of worsening epigastric pain associated with nausea and vomiting. Laboratory parameters on admission revealed high lipase: 1796 U/L (normal range 0-160 U/L), high blood glucose level: 300 mg/dl, anion gap metabolic acidosis, ketonuria, significant hyperlipidemia (triglyceride: 1226 mg/dl (normal range <150 mg/dl), and LDL cholesterol: 307 mg/dl (normal range <100 mg/dl)). Treatment with intravascular volume and electrolytes replacement as well as administration of intravenous insulin successfully resolved diabetic ketoacidosis (DKA) and hypertriglyceridemia (HTG) with a drop in triglyceride (TG) level from 1226 mg/dl to 193 mg/dl. Radiologic imaging studies by ultrasonography (USG) and CT of the abdomen showed features suggestive of interstitial pancreatitis. Glycated hemoglobin (HbA1) was 10.7% suggesting uncontrolled diabetes mellitus. Here, we explain the possible pathophysiology and management of this uncommon triad-DKA, hypertriglyceridemia, and acute pancreatitis-followed by discussion and literature review, which highlight the diagnostic challenge and possible relation of the severity of pancreatitis with the degree of hypertriglyceridemia.

Authors+Show Affiliations

Internal Medicine, Interfaith Medical Centre, Brooklyn, USA.Internal Medicine, Interfaith Medical Centre, Brooklyn, USA.Internal Medicine, Interfaith Medical Center, Brooklyn, USA.Internal Medicine, Interfaith Medical Center, Brooklyn, USA.Internal Medicine, Interfaith Medical Center, Brooklyn, USA.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31431836

Citation

Timilsina, Sanjay, et al. "Triad of Diabetic Ketoacidosis, Hypertriglyceridemia, and Acute Pancreatitis: Severity of Acute Pancreatitis May Correlate With the Level of Hypertriglyceridemia." Cureus, vol. 11, no. 6, 2019, pp. e4930.
Timilsina S, Timilsina S, Mandal A, et al. Triad of Diabetic Ketoacidosis, Hypertriglyceridemia, and Acute Pancreatitis: Severity of Acute Pancreatitis May Correlate with the Level of Hypertriglyceridemia. Cureus. 2019;11(6):e4930.
Timilsina, S., Timilsina, S., Mandal, A., Paudel, R., & Gayam, V. (2019). Triad of Diabetic Ketoacidosis, Hypertriglyceridemia, and Acute Pancreatitis: Severity of Acute Pancreatitis May Correlate with the Level of Hypertriglyceridemia. Cureus, 11(6), e4930. https://doi.org/10.7759/cureus.4930
Timilsina S, et al. Triad of Diabetic Ketoacidosis, Hypertriglyceridemia, and Acute Pancreatitis: Severity of Acute Pancreatitis May Correlate With the Level of Hypertriglyceridemia. Cureus. 2019 Jun 18;11(6):e4930. PubMed PMID: 31431836.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Triad of Diabetic Ketoacidosis, Hypertriglyceridemia, and Acute Pancreatitis: Severity of Acute Pancreatitis May Correlate with the Level of Hypertriglyceridemia. AU - Timilsina,Sanjay, AU - Timilsina,Sambida, AU - Mandal,Amrendra, AU - Paudel,Rabin, AU - Gayam,Vijay, Y1 - 2019/06/18/ PY - 2019/8/22/entrez PY - 2019/8/23/pubmed PY - 2019/8/23/medline KW - acute pancreatitis KW - diabetic ketoacidosis KW - hypertriglyceridemia SP - e4930 EP - e4930 JF - Cureus JO - Cureus VL - 11 IS - 6 N2 - A 50-year-old African-American male with no known previous medical comorbidities presented to the emergency room with complaints of three days of worsening epigastric pain associated with nausea and vomiting. Laboratory parameters on admission revealed high lipase: 1796 U/L (normal range 0-160 U/L), high blood glucose level: 300 mg/dl, anion gap metabolic acidosis, ketonuria, significant hyperlipidemia (triglyceride: 1226 mg/dl (normal range <150 mg/dl), and LDL cholesterol: 307 mg/dl (normal range <100 mg/dl)). Treatment with intravascular volume and electrolytes replacement as well as administration of intravenous insulin successfully resolved diabetic ketoacidosis (DKA) and hypertriglyceridemia (HTG) with a drop in triglyceride (TG) level from 1226 mg/dl to 193 mg/dl. Radiologic imaging studies by ultrasonography (USG) and CT of the abdomen showed features suggestive of interstitial pancreatitis. Glycated hemoglobin (HbA1) was 10.7% suggesting uncontrolled diabetes mellitus. Here, we explain the possible pathophysiology and management of this uncommon triad-DKA, hypertriglyceridemia, and acute pancreatitis-followed by discussion and literature review, which highlight the diagnostic challenge and possible relation of the severity of pancreatitis with the degree of hypertriglyceridemia. SN - 2168-8184 UR - https://www.unboundmedicine.com/medline/citation/31431836/Triad_of_Diabetic_Ketoacidosis_Hypertriglyceridemia_and_Acute_Pancreatitis:_Severity_of_Acute_Pancreatitis_May_Correlate_with_the_Level_of_Hypertriglyceridemia_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31431836/ DB - PRIME DP - Unbound Medicine ER -
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