ESPE Abstracts

Introduction: Ketoacidosis is an acute metabolic complication often indicative of diabetes in children. It can be severe and life-threatening, especially when complicated by major hypertriglyceridemia (HTg). This association is rare in pediatrics but should not be overlooked.

Observation: A 8-year-old girl admitted for treatment of severe diabetic ketoacidosis (DKA). The biological assessment, apart from the diagnostic criteria, revealed an opalescent appearance of the serum with a blood sugar level of 27.5 mmol/L and an HTg of 96 mmol/L. The lipidogram showed a high rate of chylomicrons and VLDL, thus confirming the diagnosis of HTg type V. Furthermore, lipase and amylase were normal. Treatment was initiated in an intensive care unit according to the DKA protocol with intensive insulin therapy and adequate hydration.

Discussion: The increase in ApoB induces an increase in VLDL and may therefore play a role in the development of HTg. In addition, insulin is an activator of lipoprotein lipase (LPL) which is the key enzyme in Tg metabolism. Insulin deficiency during type 1 diabetes therefore induces a reduction in LPL activity and can therefore induce or aggravate HTg. Type V HTg cannot, however, be explained by these factors alone; one or more LPL mutations are therefore suspected. It is in order to identify the LPL mutation involved that a molecular study is essential.

Conclusion: Any patient suffering from major HTg complicating DKA must be informed of the risk of overeating and the importance of consulting in the event of the occurrence of abdominal pain which could reveal a real emergency, namely acute pancreatitis.