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A rare case of diabetic ketoacidosis presenting with severe hypertriglyceridemia requiring plasmapheresis in an adult with type-2 diabetes mellitus: Case report. | LitMetric

AI Article Synopsis

  • Severe hypertriglyceridemia (HTG) is a rare but serious complication linked to insulin resistance, particularly noted in a case of diabetic ketoacidosis (DKA) in an adult with type-2 diabetes.
  • A 51-year-old man presented with abdominal pain and nausea, diagnosed with DKA and extremely high triglyceride levels over 10,000 mg/dL, indicating severe HTG, along with mild acute pancreatitis noted on a CT scan.
  • The patient's condition improved significantly after treatment with albumin-bound plasmapheresis and insulin therapy, demonstrating the need for awareness and prompt management of severe HTG in diabetic patients.

Article Abstract

Introduction: Severe hypertriglyceridemia (HTG) is a rare complication of insulin resistance. Its presentation with diabetic ketoacidosis (DKA) has been reported in a few cases, where most patients have type-1 diabetes mellitus (DM). Our case represents a unique presentation of DKA associated with severe HTG above 10,000 mg/dL in an adult with type-2 DM.

Patient Concerns And Diagnosis: Case Report: A 51-year-old man with no prior illnesses presented to the emergency department with abdominal pain and nausea. He was found to have DKA with a blood glucose level of 337 mg/dL, pH of 7.17, beta-hydroxybutyrate of 7.93 mmol/L, and anion gap of 20 mmol/L. His triglyceride levels were >10,000 mg/dL. His serum was found to be lipemic. Computerized tomography scan of the abdomen demonstrated mild acute pancreatitis. Negative GAD65 antibodies supported the diagnosis of type-2 DM.

Interventions And Outcomes: Endocrinology was consulted and one cycle of albumin-bound plasmapheresis was administered. This therapy significantly improved his HTG. DKA gradually resolved with insulin therapy as well. He was discharged home with endocrinology follow-up.

Conclusion: This unique case highlights an uncommon but critical consequence of uncontrolled DM. It brings forth the possibility of severe HTG presenting as a complication of uncontrolled type-2 DM. Severe HTG commonly presents with acute pancreatitis, which can be debilitating if not managed promptly. Most patients with this presentation are managed with insulin infusion. The use of plasmapheresis for management of severe HTG has not been well studied. Our case supports the use of plasmapheresis as an effective and rapid treatment for severe HTG.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202650PMC
http://dx.doi.org/10.1097/MD.0000000000026237DOI Listing

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