Introduction: In diabetes type 1 damage of pancreatic beta cells results in insulin deficiency and it can lead to many clinical and biochemical complications, including hypertriglyceridemia. Triglycerides level over 500mg/dl significantly increases the risk of acute pancreatitis which, in combination with ketoacidosis, can worsen the prognosis of patients.
A case report: A 9 year old patient was admitted to the Pediatric Diabetes Department due to severe ketoacidosis in newly diagnosed diabetes. For about 2 months he had been having diabetes symptoms, polydipsia, polyuria, nycturia and bed wetting every few days for 5 month before diagnosis. He also reported weight loss 3 kg during the last 5 months. Family history regarding dylipidemic disorders was negative.
On admission patient was in the fair condition with symptoms of dehydration .
Patient did not complain about abdominal pain.
In laboratory tests glucose level was 530mg%, ketones 4.5 mmol/l, metabolic acidosis: pH 7.198; BE -19.5, sodium 141 mmol/l and due to lipemic blood serum triglicerides were checked and result was 13,000mg /dl (N<100 mg/dl). HbA1c level of 15%. Elevated anti-GAD and anti-pancreas antibodies were present. Lipase level and C reactive protein were tested and were elevated.
During hospitalization the patient was treated with intravenous insulin and heparin infusion, resulting in normalization of blood biochemical parameters and clinical condition of the patient. Due to elevated pancreatic enzymes with high triglycerides levels intravenous treatment was coducted longer to achieve normalization of biochemical parameters.
After three months glucose levels were well controlled and trigliceride level was 73mg/dl.
A genetic test for lipoprotein lipase mutation is planned.
Conclusions: Patients with diabetic ketoacidosis may present severe hipertrigyceridemia and be in risk of acute pancreatitis. When severe hypertriglyceridemia is diagnosed patients require individual treatment.
Study funded: ST 120
19 - 21 Sep 2019
European Society for Paediatric Endocrinology