An enigmatic triad of acute pancreatitis, diabetic ketoacidosis and hypertriglyceridaemia: who is the culprit?

Abstract

Acute pancreatitis(AP) is one of the common causes of acute abdomen and known to be associated with high morbidity and mortality in severe cases. Though most common causes of AP are cholelithiasis and alcoholism, it has also been reported in association with diabetic ketoacidosis (DKA). Triad of AP, hypertriglyceridaemia (HTG) and DKA is rare co-association and here the causal factor of AP is still not fully established. We report a case of AP in a DKA patient with recent diagnosis of hyperlipidaemia and diabetes. Usually AP has been associated with severe HTG; interestingly, our patient showed only moderate raise in triglycerides but still suffered AP during DKA. Hence, it raises question about the real culprit in this enigmatic triad.

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

“…Moderate hyperlipidemia (usually <400 mg/dL) is secondary to AP and should not be confused with hypertriglyceridemia‐induced AP. Mild to moderate hypertriglyceridemia is an epiphenomenon to AP in patients with diabetes 2 . Increased mortality in patients with the triad as well as in patients with concomitant AP and DKA can be addressed in the intensive care unit for the DKA and/or for the severity of AP.…”

“…Mild to moderate hypertriglyceridemia is an epiphenomenon to AP in patients with diabetes. 2 Increased mortality in patients with the triad as well as in patients with concomitant AP and DKA can be addressed in the intensive care unit for the DKA and/or for the severity of AP. Notably, owing to the similarity of clinical presentation between AP and DKA, AP can be underdiagnosed.…”

“…Acute pancreatitis (AP) is a common gastrointestinal disease, the incidence of which ranges from 5 to 30 patients per 100 000 individuals, and is associated with a fatality rate of ∼5%. In the absence of gallstones or history of alcohol use, hypertriglyceridemia is the third leading cause of AP, accounting for 2%‐7% of cases with AP 1,2 . Up to 26% of patients with severe hypertriglyceridemia experience at least one attack of AP in their lifetime 3 .…”

“…In the absence of gallstones or history of alcohol use, hypertriglyceridemia is the third leading cause of AP, accounting for 2%-7% of cases with AP. 1,2 Up to 26% of patients with severe hypertriglyceridemia experience at least one attack of AP in their lifetime. 3 Fasting triglyceride levels of 1000-1999 mg/dL and ≥2000 mg/dL is indicate severe and very severe hypertriglyceridemia, respectively, and are associated with a risk of developing AP.…”

Hypertriglyceridemia–Induced Acute Pancreatitis in a Patient With Type 2 Diabetes Mellitus

“…Eruptive xanthoma associated with hypertriglyceridemia (HTG), occurs either as a result of primary (familial) or secondary causes such as poorly controlled diabetes, elevated body mass index (BMI), or alcohol abuse, or a combination of both [ 2 ]. In some patients, a triad of diabetic ketoacidosis (DKA), HTG, and acute pancreatitis (AP) were also described [ 3 , 5 ]. Therefore, early recognition can prevent the progression of disease and aid aggressive treatment to minimize the complications associated with FHTG [ 2 ].…”