Diabetic Ketoacidosis With Hypertriglyceridemia-Induced Acute Pancreatitis As First Presentation Of Diabetes Mellitus: Report Of Three Cases
ABSTRACT: Objective:We present a series of three cases of hypertriglyceridemia-induced acute pancreatitis with concurrent diabetic ketoacidosis (DKA) as first presentation of type 2 diabetes mellitus in adult patients. This triad has been described in previous literature; however, it is extremely ra...
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| Format: | Article |
| Language: | English |
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Elsevier
2017-01-01
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| Series: | AACE Clinical Case Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2376060520301760 |
| _version_ | 1818950148474011648 |
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| author | Yuchen Wang, MD Bashar M. Attar, MD, PhD Sara Bedrose, MD William Trick, MD Oscar Rivas-Chicas, MD Carlos Roberto Simons-Linares, MD Chioma Onyenwenyi, MD Sisir Siddamesetti, MD Leon Fogelfeld, MD |
| author_facet | Yuchen Wang, MD Bashar M. Attar, MD, PhD Sara Bedrose, MD William Trick, MD Oscar Rivas-Chicas, MD Carlos Roberto Simons-Linares, MD Chioma Onyenwenyi, MD Sisir Siddamesetti, MD Leon Fogelfeld, MD |
| author_sort | Yuchen Wang, MD |
| collection | DOAJ |
| description | ABSTRACT: Objective:We present a series of three cases of hypertriglyceridemia-induced acute pancreatitis with concurrent diabetic ketoacidosis (DKA) as first presentation of type 2 diabetes mellitus in adult patients. This triad has been described in previous literature; however, it is extremely rare in previously undiagnosed diabetic patients. We discuss the potential mechanism, diagnosis, management strategies, and prognosis in these cases.Methods:Three patients with no known history of diabetes mellitus or hyperlipidemia presented with diabetic ketoacidosis, elevated serum triglycerides, and typical symptoms of acute pancreatitis. Diagnosis was confirmed with abdominal computed tomography (CT) scan, and all three patients were managed in intensive care units, received aggressive fluid repletion, intravenous insulin, and lipid-lowering agents.Results:Two patients had uneventful recovery with rapid resolving hyperglycemia and hypertriglyceridemia. One patient had severe complication of acute kidney injury, sepsis, and acute respiratory distress syndrome, requiring temporary continuous veno-veno hemodialysis, antibiotic treatment, and transient intubation. All patients were discharged on subcutaneous insulin and lipid-lowering agents. They remained symptom-free during follow-ups.Conclusion: The triad of DKA with concurrent hypertriglyceridemia-induced acute pancreatitis occurs in approximately 4% of DKA cases. However, it is extremely rare as first presentation of diabetes in adult patients. A prompt diagnosis is challenging, although crucial for appropriate management. CT scan and lipid panel should be performed to confirm diagnosis when there is clinical suspicion or no improvement after treatment of DKA. Management mainly consist of intravenous fluids, continuous insulin infusion, and lipid-lowering agents. Plasmapheresis with success has been reported in previous literature; however, it was not necessary in our cases.Abbreviations:ABGarterial blood gasAPacute pancreatitisCTcomputed tomographyDKAdiabetic ketoacidosis |
| first_indexed | 2024-12-20T09:13:59Z |
| format | Article |
| id | doaj.art-f63fa5f1e9af495785547912fed41f29 |
| institution | Directory Open Access Journal |
| issn | 2376-0605 |
| language | English |
| last_indexed | 2024-12-20T09:13:59Z |
| publishDate | 2017-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AACE Clinical Case Reports |
| spelling | doaj.art-f63fa5f1e9af495785547912fed41f292022-12-21T19:45:28ZengElsevierAACE Clinical Case Reports2376-06052017-01-0133e195e199Diabetic Ketoacidosis With Hypertriglyceridemia-Induced Acute Pancreatitis As First Presentation Of Diabetes Mellitus: Report Of Three CasesYuchen Wang, MD0Bashar M. Attar, MD, PhD1Sara Bedrose, MD2William Trick, MD3Oscar Rivas-Chicas, MD4Carlos Roberto Simons-Linares, MD5Chioma Onyenwenyi, MD6Sisir Siddamesetti, MD7Leon Fogelfeld, MD8Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, Illinois; Address correspondence to Dr. Yuchen Wang, 1344 West Grenshaw Avenue, Chicago, IL 60607.Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IllinoisInternal Medicine, John H. Stroger Hospital of Cook County, Chicago, IllinoisInternal Medicine, John H. Stroger Hospital of Cook County, Chicago, IllinoisInternal Medicine, John H. Stroger Hospital of Cook County, Chicago, IllinoisInternal Medicine, John H. Stroger Hospital of Cook County, Chicago, IllinoisDepartment of Endocrinology, Diabetes and Metabolism, RUSH University Medical Center, Chicago, Illinois.Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IllinoisDepartment of Endocrinology, Diabetes and Metabolism, RUSH University Medical Center, Chicago, Illinois.ABSTRACT: Objective:We present a series of three cases of hypertriglyceridemia-induced acute pancreatitis with concurrent diabetic ketoacidosis (DKA) as first presentation of type 2 diabetes mellitus in adult patients. This triad has been described in previous literature; however, it is extremely rare in previously undiagnosed diabetic patients. We discuss the potential mechanism, diagnosis, management strategies, and prognosis in these cases.Methods:Three patients with no known history of diabetes mellitus or hyperlipidemia presented with diabetic ketoacidosis, elevated serum triglycerides, and typical symptoms of acute pancreatitis. Diagnosis was confirmed with abdominal computed tomography (CT) scan, and all three patients were managed in intensive care units, received aggressive fluid repletion, intravenous insulin, and lipid-lowering agents.Results:Two patients had uneventful recovery with rapid resolving hyperglycemia and hypertriglyceridemia. One patient had severe complication of acute kidney injury, sepsis, and acute respiratory distress syndrome, requiring temporary continuous veno-veno hemodialysis, antibiotic treatment, and transient intubation. All patients were discharged on subcutaneous insulin and lipid-lowering agents. They remained symptom-free during follow-ups.Conclusion: The triad of DKA with concurrent hypertriglyceridemia-induced acute pancreatitis occurs in approximately 4% of DKA cases. However, it is extremely rare as first presentation of diabetes in adult patients. A prompt diagnosis is challenging, although crucial for appropriate management. CT scan and lipid panel should be performed to confirm diagnosis when there is clinical suspicion or no improvement after treatment of DKA. Management mainly consist of intravenous fluids, continuous insulin infusion, and lipid-lowering agents. Plasmapheresis with success has been reported in previous literature; however, it was not necessary in our cases.Abbreviations:ABGarterial blood gasAPacute pancreatitisCTcomputed tomographyDKAdiabetic ketoacidosishttp://www.sciencedirect.com/science/article/pii/S2376060520301760 |
| spellingShingle | Yuchen Wang, MD Bashar M. Attar, MD, PhD Sara Bedrose, MD William Trick, MD Oscar Rivas-Chicas, MD Carlos Roberto Simons-Linares, MD Chioma Onyenwenyi, MD Sisir Siddamesetti, MD Leon Fogelfeld, MD Diabetic Ketoacidosis With Hypertriglyceridemia-Induced Acute Pancreatitis As First Presentation Of Diabetes Mellitus: Report Of Three Cases AACE Clinical Case Reports |
| title | Diabetic Ketoacidosis With Hypertriglyceridemia-Induced Acute Pancreatitis As First Presentation Of Diabetes Mellitus: Report Of Three Cases |
| title_full | Diabetic Ketoacidosis With Hypertriglyceridemia-Induced Acute Pancreatitis As First Presentation Of Diabetes Mellitus: Report Of Three Cases |
| title_fullStr | Diabetic Ketoacidosis With Hypertriglyceridemia-Induced Acute Pancreatitis As First Presentation Of Diabetes Mellitus: Report Of Three Cases |
| title_full_unstemmed | Diabetic Ketoacidosis With Hypertriglyceridemia-Induced Acute Pancreatitis As First Presentation Of Diabetes Mellitus: Report Of Three Cases |
| title_short | Diabetic Ketoacidosis With Hypertriglyceridemia-Induced Acute Pancreatitis As First Presentation Of Diabetes Mellitus: Report Of Three Cases |
| title_sort | diabetic ketoacidosis with hypertriglyceridemia induced acute pancreatitis as first presentation of diabetes mellitus report of three cases |
| url | http://www.sciencedirect.com/science/article/pii/S2376060520301760 |
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