Strawberry pink blood: hypertriglyceridaemia and diabetic ketoacidosis secondary to poorly controlled type 2 diabetes mellitus

Abstract

A 54-year-old woman with insulin-requiring type 2 diabetes mellitus presented with acute shortness of breath and drowsiness on a background of polydipsia, weakness and significant weight loss. One year ago, she had decided to stop her insulin and other medications and adopt lifestyle modifications instead. Initial emergency department (ED) blood samples were highly lipaemic and appeared strawberry pink. She was eventually diagnosed with diabetic ketoacidosis (DKA) with severe hypertriglyceridaemia, intubated for airway protection, and managed with fluid resuscitation and intravenous insulin to good effect. We share an uncommon DKA presentation at the ED. History was limited as the patient was drowsy and minimally communicative. Physical examination was unremarkable. Blood investigations were also delayed in view of the need for additional centrifugation. These contributed to a paucity of information in the acute setting and resulted in a diagnostic challenge.

Sirolimus-Induced Severe Hypertriglyceridemia Presenting with Signs of Hyperviscosity Syndrome and as Pink Colored Blood: A Case Report

“…Reports on severe hypertriglyceridemia associated with sirolimus treatment are rare, however have to be considered amongst the differential diagnoses (Box 1). Literature searches revealed that levels that high as in our index case have not been observed before [23][24][25]. Comingling of the red blood cells with the white appearing triglycerides are responsible for the phenomenon of pink colored blood [26].…”

Avicennas Perception of Blood Properties Compared With Current Biomedical Knowledge

“…Plasma is cloudy and milky-colored in individuals who donate Blood after eating a fatty breakfast (15). A lipemic Blood sample is the color of strawberry milkshake, and the plasma is milky white due to the presence of fat particles (16,17). A cherry-colored plasma indicates hemolysis (15).…”

“…In bacterial infections, the color of Blood changes to dark crimson or black (15,17). When dealing with abnormal Blood color in a critically-ill patient, differential diagnoses include cyanide poisoning, dyshemoglobinemias (e.g., methemoglobinemia and carboxyhemoglobin), lipemia and drug overdose should be considered (16). The color of menstruation Blood can be black, red-brown/black, light red, pink, orange or gray.…”