Concurrent Diabetic Ketoacidosis and Acute Pancreatitis in Mild Hypertriglyceridemia: An Enigmatic Triangle

Abstract

Hypertriglyceridemia (HTG) is a well-established cause of acute pancreatitis (AP). Diabetic ketoacidosis (DKA) leads to lipolysis and HTG, and can result in AP. Triad of AP, DKA, and HTG is rare and not fully understood. Usually AP is associated with severe HTG with serum triglyceride (TG) level over 1,000 mg/dL. However, we experienced two cases of AP in DKA with mild HTG with TG level less than 200 mg/dL. Herein, we report these unusual cases and provide a review of the literature about the triad of DKA, HTG, and AP.

Devastating Effects of Combined DKA and Acute Pancreatitis in Select Patients: Two Cases

“…And regardless of the association of AP with a triglyceride level over 1000 mg/dL, AP has been reported in patients with DKA and lower triglyceride levels. 9 Although our second patient has the history of type 2 diabetes, the presence of AP may further worsen insulin resistance and result into DKA. Acute pancreatitis triggered by any mechanism can result into beta cell dysfunction thereby causing transient insulin deficiency (T1DM) or insulin resistance (T2DM) thus possibly triggering DKA.…”