Background: Severe hypertriglyceridemia (HTG) is a very rare complication of childhood diabetic ketoacidosis (DKA). The exact mecanism is unclear but transient insulin deficiency may cause a decrease in the activity of lipoprotein lipase. We report a case of girl with DKA and HTG.
Case report: A 14-year-old girl, previously healthy and nonobese, presented with DKA following two months malaise, two weeks of polyuria and polydipsia. She was found to have DKA with her initial blood gas showing a pH of 6.80, HCO3 4.1 mmol/l, and anyon gap 28 on arrival to our PICU. Her physical examination revealed severe dehydration, decreasing level of consciousness, and her blood gas continued to show a severe metabolic acidosis. The colour of her serum was milky. Other biochemical values at admission could not be accurately measured because of severe HTG. The girl was treated with insulin and fluid according to the standard DKA treatment protocol. After 38 hours, blood gases had normalised and subcutaneous insulin was commenced. Her plasma triglyceride level was 2106 mg/dl after 12 hours of treatment without abdominal pain and declined 1521 mg/dl at second day. Serum amilase was 178 U/l on day 2 and decreased to 55 U/L at 4th day. Serum triglyceride levels were monitored and gradually reduced to 362 mg/dl at fifth day and normalised on day 10. On outpatient follow-up, no underlying lipid disorders were found and serum triglyceride level stayed normal.
Conclusion: HTG results from absolute insulin deficiency and increases the risk of acute pancreatitis. Abnormalities in the gene for lipoprotein lipase could be implicated of severe HTG. Although experience regarding HTG in DKA is very limited in pediatric patients, our patient recovered with DKA treatment protocol without plasmapheresis or special medical treatment and no primary lipid metabolism disorders were found.
01 Oct 2015 - 03 Oct 2015