Hypertriglyceridemia-Induced Pancreatitis Complicated by Diabetic Ketoacidosis

Abstract

Acute pancreatitis is a potentially fatal clinical entity having multiple underlying triggers. Though the incidence of hypertriglyceridemia-induced pancreatitis is low; however, patients with such risk factors develop severe disease. We present a case of a 47-year-old male who came to our facility with complaints of epigastric pain. Physical examination and laboratory workup unmasked the presence of pancreatitis alongside concurrent diabetic ketoacidosis (DKA). This presentation is unique, and to our knowledge, only a few cases have been reported in the literature. Furthermore, the co-existence of pancreatitis and DKA can overlap the clinical picture of each other, which might lead to unwanted complications if not diagnosed timely.

Diagnostic and Therapeutic Ambiguities in Diabetic Ketoacidosis With Overlapping Acute Pancreatitis and Hypertriglyceridemia

“…This approach should not be misconstrued as using CT for diagnosis; rather, it is to rule out or confirm serious complications that could significantly alter patient management. In 2021, a case report urged the need for imaging for proper diagnosis of pancreatitis in the setting of superimposed DKA [6].…”

Acute Pancreatitis, Hypertriglyceridemia, and Diabetic Ketoacidosis: A Life-Threatening Triad

“…Narala et al have described a case of acute pancreatitis induced by HTG concurrent with DKA as an initial manifestation of type 2 DM [8]. Naqvi S et al reported a case of the life-threatening triad of acute pancreatitis, DKA, and HTG due to poor compliance with DM treatment measures [9].…”

“…This can be achieved through dietary modification, lipid-lowering medications, and, in severe cases, therapeutic plasma exchange or plasmapheresis [7,8]. Intravenous hydration, pain management, and nutritional support are essential components of pancreatitis management [9]. In HTG-induced acute pancreatitis, intravenous insulin can be used for the treatment of severe HTG and it is associated with simple initiation and generally good patient tolerance.…”