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Adams KJ, Khadka S, Sherpa D, Saliba N. A Complicated Triad of Diabetic Ketoacidosis, Hypertriglyceridemia, and Acute Pancreatitis in a Patient With Alcohol Abuse and Undiagnosed Diabetes Mellitus. Cureus 2024; 16:e75418. [PMID: 39791034 PMCID: PMC11717404 DOI: 10.7759/cureus.75418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 10/16/2024] [Accepted: 12/09/2024] [Indexed: 01/12/2025] Open
Abstract
Diabetic ketoacidosis (DKA), hypertriglyceridemia, and acute pancreatitis are a rare and potentially fatal triad. This article presents a fatal case of acute pancreatitis, DKA, and hypertriglyceridemia in a patient with undiagnosed diabetes mellitus struggling with alcoholism. The patient was unresponsive to standard pancreatitis and DKA treatment protocol and progressed to develop multi-organ failure. Despite best efforts, the patient expired on day five of admission.
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Affiliation(s)
- Kenneth J Adams
- Medical School, Edward Via College of Osteopathic Medicine, Auburn, USA
| | | | - Diki Sherpa
- Internal Medicine, Crestwood Medical Center, Huntsville, USA
| | - Natalie Saliba
- Medical School, Edward Via College of Osteopathic Medicine, Auburn, USA
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2
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Price CR, Kendle A, Cain MA. A Case of Acute Hypertriglyceridemia-Induced Pancreatitis in Pregnancy and Its Clinical Implications. Case Rep Endocrinol 2024; 2024:5896861. [PMID: 39421549 PMCID: PMC11486530 DOI: 10.1155/2024/5896861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 09/29/2022] [Revised: 04/14/2024] [Accepted: 08/17/2024] [Indexed: 10/19/2024] Open
Abstract
Acute hypertriglyceridemia-induced pancreatitis (HTGP) is an uncommon occurrence during pregnancy. Prompt diagnosis and initiation of treatment are indicated to prevent adverse maternal and neonatal outcomes. We present the case of a pregnant female who was diagnosed with HTGP at 34 weeks gestation and subsequently developed diabetic ketoacidosis (DKA) and preeclampsia with severe features. We describe the pathophysiology of acute HTGP and its relation to the gravid state and review available treatment options though data remains limited. Our case emphasizes the potential sequelae of HTGP in pregnancy, the need for a multidisciplinary approach for optimal care, and the importance of early treatment in improving maternal and neonatal outcomes.
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Affiliation(s)
- Corley Rachelle Price
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Anthony Kendle
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Mary Ashley Cain
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
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Lourinho J, Proença J, Santos L, Leite V, Ramalho S, Escarigo C. Diabetic Ketoacidosis and Hypertriglyceridemia-Induced Acute Pancreatitis Requiring Plasmapheresis: A Case Report of a Rare Presentation of Type 2 Diabetes Mellitus in Adults. Cureus 2024; 16:e52679. [PMID: 38380218 PMCID: PMC10878739 DOI: 10.7759/cureus.52679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Accepted: 01/21/2024] [Indexed: 02/22/2024] Open
Abstract
The triad of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis is a rare presentation of diabetes mellitus type 2 in adults. We report a case of a 41-year-old male who presented at the emergency department with a sudden onset of severe abdominal pain. Diagnosis of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis was made. Triglyceride level was 6056 mg/dL and glycated hemoglobin was 12.6%. Vigorous fluid therapy and continuous infusion of insulin were started, but due to maintained symptoms, a single plasmapheresis session was performed, with significant clinical improvement. This case emphasizes the diagnostic challenges of the triad and highlights the potential role of plasmapheresis in rapidly reducing triglyceride levels.
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Affiliation(s)
- João Lourinho
- Infectious Disease, Hospital Garcia de Orta, Almada, PRT
| | - José Proença
- Internal Medicine, Hospital Garcia de Orta, Almada, PRT
| | | | - Vanessa Leite
- Internal Medicine, Hospital Garcia de Orta, Almada, PRT
| | - Sara Ramalho
- Internal Medicine, Hospital Garcia de Orta, Almada, PRT
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Oshikoya AF, Kumari N, Bai M, Suman F, Haseeb M. Acute Pancreatitis, Hypertriglyceridemia, and Diabetic Ketoacidosis: A Life-Threatening Triad. Cureus 2023; 15:e45631. [PMID: 37868435 PMCID: PMC10588976 DOI: 10.7759/cureus.45631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Hypertriglyceridemia (HTG)-induced pancreatitis is a known complication of uncontrolled diabetes mellitus (DM). However, the coexistence of diabetic ketoacidosis (DKA) and acute pancreatitis in the presence of HTG is rare and presents diagnostic and therapeutic challenges. We present the case of a 42-year-old female with poorly controlled type 2 DM who developed severe HTG-induced pancreatitis complicated by DKA. She initially presented with abdominal pain, metabolic acidosis, and marked hyperglycemia. Subsequent investigations revealed significantly elevated serum triglyceride and lipase levels and characteristic findings of acute pancreatitis on imaging. This case report highlights the complex interplay of metabolic disturbances in diabetes and the importance of timely recognition and tailored management to achieve a successful outcome.
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Affiliation(s)
- Adetola F Oshikoya
- Medicine, Near East University, Nicosia, CYP
- General Practice, General Hospital Odan, Lagos Island, Lagos, NGA
| | - Nikita Kumari
- Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, PAK
| | - Manita Bai
- Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, PAK
| | - Fnu Suman
- Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, PAK
| | - Muhammad Haseeb
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
- Internal Medicine, Bahria International Hospital, Lahore, PAK
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Morare N, Herbst JP, Khalil M, Ally Z. Enigmatic Triad: Concomitant Hypertriglyceridemia, Diabetic Ketoacidosis, and Acute Pancreatitis. Pancreas 2022; 51:e3-e4. [PMID: 35195605 DOI: 10.1097/mpa.0000000000001968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 12/10/2022]
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Narala B, Al-Tkrit A, David S, Alataby H, Nfonoyim J. A Fatal Case of Hypertriglyceridemia-Induced Acute Pancreatitis in a Patient With Diabetic Ketoacidosis. Cureus 2021; 13:e14968. [PMID: 34123664 PMCID: PMC8191687 DOI: 10.7759/cureus.14968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/06/2022] Open
Abstract
Diabetic ketoacidosis (DKA) with coexisting hypertriglyceridemia-induced acute pancreatitis is a rare yet potentially life-threatening condition. This report describes a patient with no history of diabetes who presented with DKA and coexisting acute pancreatitis secondary to severe hypertriglyceridemia. The patient did not respond to standard DKA management or plasmapheresis, developed acute respiratory distress syndrome (ARDS), and eventually expired.
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Affiliation(s)
- Bhavya Narala
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Amna Al-Tkrit
- Internal Medicine, Jamaica Hospital Medical Center, Richmond Hill, USA
| | - Sharoon David
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Harith Alataby
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Jay Nfonoyim
- Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA
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Mills K, Aniekwena J, Cochran T, Nsofor E, Bakinde N. A Rare Triad: Hypercalcemia-Induced Necrotizing Pancreatitis Presenting as Severe Diabetic Ketoacidosis. J Investig Med High Impact Case Rep 2021; 9:2324709621998477. [PMID: 33631992 PMCID: PMC7917841 DOI: 10.1177/2324709621998477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/25/2022] Open
Abstract
Primary hyperparathyroidism (PHPT) typically occurs in persons above 45 years, with a
female predominance. PHPT induces a state of hypercalcemia, but acute pancreatitis is a
rare sequelae of this hypercalcemia. We report a case of a 31-year-old man with no known
medical history who presented in diabetic ketoacidosis with electrolyte abnormalities. His
clinical course progressed to multi-organ dysfunction despite correction of metabolic
derangements. Further workup led to the discovery of the uncommon triad by which
previously undiagnosed PHPT precipitated severe diabetic ketoacidosis.
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Ramachandran V, Vila DM, Cochran JM, Caruso AC, Balchandani R. Acute pancreatitis secondary to hypertriglyceridemia precipitated by diabetic ketoacidosis in a previously undiagnosed ketosis-prone patient with diabetes mellitus. Proc AMIA Symp 2018; 31:189-191. [PMID: 29706815 DOI: 10.1080/08998280.2018.1435123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 10/13/2017] [Revised: 12/22/2017] [Accepted: 12/28/2017] [Indexed: 10/17/2022] Open
Abstract
Diabetic ketoacidosis is a potentially fatal complication of diabetes mellitus that may result in hypertriglyceridemia. Rarely, the resulting hypertriglyceridemia may precipitate acute pancreatitis. We report a case of acute pancreatitis secondary to hypertriglyceridemia precipitated by diabetic ketoacidosis and postulate that this unusual presentation is due to the patient being prone to ketosis.
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Affiliation(s)
| | - Diana M Vila
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - John M Cochran
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Andrew C Caruso
- Department of Medicine, Baylor College of Medicine, Houston, Texas.,Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Rajeev Balchandani
- Department of Medicine, Baylor College of Medicine, Houston, Texas.,Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas
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