Severe Hypertriglyceridemia Causing Pancreatitis in a Child with New-onset Type-I Diabetes Mellitus Presenting with Diabetic Ketoacidosis

Sharma, Pradeep; Kumar, Maneesh; Yadav, Dinesh Kumar

doi:10.4103/ijccm.ijccm_281_16

Cited by 16 publications

(19 citation statements)

References 10 publications

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“…Through a literature review of previous case reports, most severe hypertriglyceridemia is observed with DKA in patients recently diagnosed with type 1 diabetes or can be attributed to poor control of diabetes in patients with severe insulin deficiency (Table 4). 27‐29 DKA patients manifest with disorders of glucose and lipid metabolism, thereby leading to hypertriglyceridemia‐induced AP.…”

Section: Discussionmentioning

confidence: 99%

Whole exome sequencing identifies three novel gene mutations in patients with the triad of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis

Huang

et al. 2020

Journal of Diabetes

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Background This study aimed to analyze the genetics and treatments of the patients with the triad of diabetic ketoacidosis (DKA), hypertriglyceridemia, and acute pancreatitis (AP). Methods We conducted a retrospective study of six patients with the triad of AP, hypertriglyceridemia, and DKA at our hospital. All patients underwent plasmapheresis as part of their treatment. The clinical characteristics of the patients were obtained from the hospital information system and analyzed. Whole exome sequencing was performed using samples of one patient (case 6) and his family members. Results The average triglyceride level before plasmapheresis was 3282.17 ± 2975.43 mg/dL (range: 1646‐9332 mg/dL). The triglyceride levels dropped by approximately 80% after plasmapheresis. None of the patients developed complications related from plasmapheresis. During follow‐up, patients 5 and 6 developed recurrent pancreatitis for several times and showed the formation of pancreatic pseudocysts. We identified three novel heterozygous missense mutations in the family of patient 6, including c.12614C > T (p.Pro4205Leu) in APOB, c.160G > C (p.Glu54Gln) in CILP2, and c.1199C > A (p.Ala400Glu) in PEPD. Conclusions Three novel heterozygous missense mutations, including c.12614C > T (p.Pro4205Leu) in APOB, c.160G > C (p.Glu54Gln) in CILP2, and c.1199C > A (p.Ala400Glu) in PEPD were first identified in a patient with the triad of DKA, hypertriglyceridemia, and AP. The combination of plasmapheresis, hydration, and insulin therapy may have the greatest clinical benefits for these patients.

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Section: Discussionmentioning

confidence: 99%

Whole exome sequencing identifies three novel gene mutations in patients with the triad of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis

Huang

et al. 2020

Journal of Diabetes

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“…Moreover, AP can be induced by diabetic ketoacidosis (DKA), complicated by hypertriglyceridemia [2]. However, and to the best of our knowledge, the association of this triad of pancreatitis, hypertriglyceridemia, and diabetic ketoacidosis and its treatment has not been widely discussed in the literature in both adults and children [3]. Rapid diagnosis is difficult due to overlapping signs, but it is crucial for adequate management.…”

Section: Introductionmentioning

confidence: 99%

Acute Pancreatitis Induced by Diabetic Ketoacidosis with Major Hypertriglyceridemia: Report of Four Cases

Bouchaala

Bahloul

Bradii

et al. 2020

Case Reports in Critical Care

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Acute pancreatitis (AP) is a real clinical challenge. Acute pancreatitis remains a common cause of emergency department consultations and a major cause for hospitalization. Gallstones and drinking a lot of alcohol are the most frequent causes of AP. Moreover, AP can be induced by diabetic ketoacidosis (DKA) complicated by hypertriglyceridemia. We report 4 cases of DKA with hypertriglyceridemia complicated by AP in previously undiagnosed diabetes patients. All of our patients presented to the emergency ward with abdominal pain. Their physical exam showed epigastric tenderness. An abdominal CT scan was performed for each patient, showing an AP grade E. Laboratory samples showed high serum glucose levels. They had metabolic acidosis with elevated anion gap. They had high lipasemia and amylasemia. Their lipid panel was disturbed with a high level of cholesterol (from 12.8 mmol/l to 33 mmol/l) and triglyceridemia (from 53 to 133 mmol/l). Our patients were admitted into our ICU where they received fluid resuscitation and intravenous insulin, and their triglycerides rates decreased gradually. Two patients recovered to a good health state, and the two others developed septic shock, requiring the use of large-spectrum antibiotics, and acute kidney injury (AKI) with refractory metabolic acidosis, requiring hemodialysis. Despite the intensive treatment, they developed an unrecoverable multiorgan failure. Through our case series, we aim to highlight the importance of making an early diagnosis, which can be difficult in some situations due to overlapping signs; however, it is crucial for a good recovery. A good understanding of the pathway of hypoinsulinemic states causing hypertriglyceridemia then AP is important because it is the key to best management.

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“…In many case reports, severe HTG is observed during DKA associated with newly diagnosed T1D [5, 6] or attributed to poor diabetes control [7] with severe insulin deficiency. In our case, the fact that his HbA1c was 11.5% signifies insulin deficiency for months, even if he did not report discontinuing his insulin therapy.…”

Section: Discussionmentioning

confidence: 99%

“…The mechanism of hypertriglyceridemia in DKA involves insulin deficiency which activate lipolysis in adipose tissue and increase the release of free fatty acid, which accelerate formation of very low-density lipoprotein by the liver [5]. Insulin deficiency is also associated with decreased activity of lipoprotein lipase (LPL), the enzyme responsible for TG metabolism, which reduces the clearance of VLDL and chylomicrons from the plasma, causing hypertriglyceridemia [8, 9].…”

Section: Discussionmentioning

confidence: 99%

“…Although severe hypertriglyceridemia is a rare condition, it may have devastating consequences such as lipidemia retinalis or acute pancreatitis [7]. Acute pancreatitis secondary to hypertriglyceridemia was reported in only 4% of DKA episodes in adults [14], and only nine cases are reported in children [5]. A triglyceride level more than 10g/L is associated with a risk of 5% for the development of acute pancreatitis; this risk is increased to 10%–20% when the triglyceride level is more than 20g/L [14]; DKA itself can cause pancreatic injury with false elevation of amylase and lipase.…”

Section: Discussionmentioning

confidence: 99%

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Diabetic Ketoacidosis Revealing a Severe Hypertriglyceridemia and Acute Pancreatitis in Type 1 Diabetes Mellitus

Zaher

Boubagura

Rafi

et al. 2019

Case Reports in Endocrinology

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Diabetic ketoacidosis (DKA) is a life-threatening acute metabolic complication occurring in patients with diabetes, especially in patients with type 1 diabetes (T1D), due to an insulin deficiency. Moderate hypertriglyceridemia is commonly observed in DKA but severe hypertriglyceridemia with a triglyceride level exceeding 10g/L is very rarely reported. We report a case of a 14-year-old boy who had type 1 diabetes for 4 years treated with insulin therapy, also having adrenal insufficiency treated with hydrocortisone who presented with ketoacidosis and excruciating abdominal pain. Investigations revealed hypertriglyceridemia at 64g/L, lipasemia at 1000 U/L, and stage E pancreatitis on abdominal CT. The patient was treated with intravenous insulin, rehydration, and fenofibrate with good clinical and biological evolution. Severe hypertriglyceridemia causing pancreatitis in type 1 diabetes mellitus is a rare but very serious complication of DKA in children.

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Severe Hypertriglyceridemia Causing Pancreatitis in a Child with New-onset Type-I Diabetes Mellitus Presenting with Diabetic Ketoacidosis

Cited by 16 publications

References 10 publications

Whole exome sequencing identifies three novel gene mutations in patients with the triad of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis

Whole exome sequencing identifies three novel gene mutations in patients with the triad of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis

Acute Pancreatitis Induced by Diabetic Ketoacidosis with Major Hypertriglyceridemia: Report of Four Cases

Diabetic Ketoacidosis Revealing a Severe Hypertriglyceridemia and Acute Pancreatitis in Type 1 Diabetes Mellitus

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