Diagnostic difficulties encountered in milky serum of a 4 year old baby with severe diabetic ketoacidosis and hypertriglyceridemia causing acute pancreatitis- A case report

Abstract

Milky/ frothy serum samples can be received sporadically in cases of severe hypertriglyceridemia which can pose diagnostic challenge for the routine processing and result generation. We report difficulties encountered in processing of such sample in undiagnosed and comatosed 4 year old girl of new onset type 1 diabetes mellitus, severe diabetic ketoacidosis and hypertriglyceridemia induced acute pancreatitis. She had markedly elevated serum triglycerides [13,846 mg/dL] with high cholesterol [1267 mg/dl], serum amylase [150 U/L], serum lipase [230 U/L], pH 6.85 and bicarbonate 6 mEq/L. Arterial blood gas analysis and urine chemistry were performed for the initial diagnosis. After establishing the diagnosis she was managed with insulin therapy and conservative management.