DKA with Severe Hypertriglyceridemia and Cerebral Edema in an Adolescent Boy: A Case Study and Review of the Literature

Tansit Saengkaew, Taninee Sahakitrungruang, Suttipong Wacharasindhu, Vichit Supornsilchai, Tansit Saengkaew, Taninee Sahakitrungruang, Suttipong Wacharasindhu, Vichit Supornsilchai

Abstract

A 13-year-old adolescent boy with type 1 diabetes mellitus (1b) presented with diabetic ketoacidosis (DKA) and cerebral edema. Grossly lipemic serum and lipemia retinals due to extremely high triglyceride (TG) level were observed without evidence of xanthoma or xanthelasma. Cerebral edema was treated by appropriate ventilation and mannitol administration. Normal saline was carefully given and regular insulin was titrated according to blood sugar levels. Triglyceride levels were reduced from 9,800 mg/dL to normal range within 9 days after conventional treatment was commenced without antilipid medication. Based on our review of the literature, this is the first reported case of confirmed pediatric DKA with severe hypertriglyceridemia and cerebral edema. In patients with DKA and hypertriglyceridemia, clinicians should be mindful of the possibility of associated acute pancreatitis and cerebral edema.

Figures

Figure 1
Figure 1
Images describing lipemic serum (a) and lipemia retinals, whitish, creamy vessels of retina (b).
Figure 2
Figure 2
Triglyceride levels after DKA treatment.

References

    1. Wolfsdorf J. I., Allgrove J., Craig M. E., et al. Ispad clinical practice consensus guidelines 2014. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatric Diabetes. 2014;15(supplement 20):154–179. doi: 10.1111/pedi.12165.
    1. Athyros V. G., Giouleme O. I., Nikolaidis N. L., et al. Long-term follow-up of patients with acute hypertriglyceridemia-induced pancreatitis. Journal of Clinical Gastroenterology. 2002;34(4):472–475. doi: 10.1097/00004836-200204000-00020.
    1. Sandhu S., Al-Sarraf A., Taraboanta C., Frohlich J., Francis G. A. Incidence of pancreatitis, secondary causes, and treatment of patients referred to a specialty lipid clinic with severe hypertriglyceridemia: a retrospective cohort study. Lipids in Health and Disease. 2011;10, article 157 doi: 10.1186/1476-511x-10-157.
    1. Nair S., Yadav D., Pitchumoni C. S. Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA. American Journal of Gastroenterology. 2000;95(10):2795–2800. doi: 10.1016/s0002-9270(00)01981-x.
    1. Qu S., Zhang T., Dong H. H. Effect of hepatic insulin expression on lipid metabolism in diabetic mice. Journal of Diabetes. 2015 doi: 10.1111/1753-0407.12293.
    1. Blackett P. R., Holcombe J. H., Alaupovic P., Fesmire J. D. Plasma lipids and apolipoproteins in a 13-year-old boy with diabetic ketoacidosis and extreme hyperlipidemia. The American Journal of the Medical Sciences. 1986;291(5):342–346. doi: 10.1097/00000441-198605000-00010.
    1. Rumbak M. J., Hughes T. A., Kitabchi A. E. Pseudonormoglycemia in diabetic ketoacidosis with elevated triglycerides. American Journal of Emergency Medicine. 1991;9(1):61–63. doi: 10.1016/0735-6757(91)90019-G.
    1. Cole R. P. Heparin treatment for severe hypertriglyceridemia in diabetic ketoacidosis. Archives of Internal Medicine. 2009;169(15):1439–1441. doi: 10.1001/archinternmed.2009.221.
    1. Wolfsdorf J., Craig M. E., Daneman D., et al. Diabetic ketoacidosis in children and adolescents with diabetes. Pediatric Diabetes. 2009;10(supplement 12):118–133. doi: 10.1111/j.1399-5448.2009.00569.x.
    1. Hahn S. J., Park J.-H., Lee J. H., Lee J. K., Kim K.-A. Severe hypertriglyceridemia in diabetic ketoacidosis accompanied by acute pancreatitis: case report. Journal of Korean Medical Science. 2010;25(9):1375–1378. doi: 10.3346/jkms.2010.25.9.1375.
    1. Lutfi R., Huang J., Wong H. R. Plasmapheresis to treat hypertriglyceridemia in a child with diabetic ketoacidosis and pancreatitis. Pediatrics. 2012;129(1):e195–e198. doi: 10.1542/peds.2011-0217.
    1. Williamson S., Alexander V., Greene S. A. Severe hyperlipidaemia complicating diabetic ketoacidosis. Archives of Disease in Childhood. 2012;97(8):p. 735. doi: 10.1136/archdischild-2012-301789.
    1. Aboulhosn K., Arnason T. Acute pancreatitis and severe hypertriglyceridaemia masking unsuspected underlying diabetic ketoacidosis. BMJ Case Reports. 2013;2013 doi: 10.1136/bcr-2013-200431.
    1. Cywinski J. S., Walker F. A., White H., Traisman H. S. Juvenile diabetes mellitus associated with acute pancreatitis. Acta paediatrica Scandinavica. 1965;54(6):597–602. doi: 10.1111/j.1651-2227.1965.tb06425.x.
    1. Slyper A. H., Wyatt D. T., Brown C. W. Clinical and/or biochemical pancreatitis in diabetic ketoacidosis. Journal of Pediatric Endocrinology. 1994;7(3):261–264.
    1. Kadota-Shinozaki A., Nakamura T.-A., Hidaka H., et al. Diabetic lipemia with maturity-onset diabetes of the young. Internal Medicine. 1997;36(8):571–574. doi: 10.2169/internalmedicine.36.571.
    1. Kota S. K., Jammula S., Kota S. K., Meher L. K., Modi K. D. Acute pancreatitis in association with diabetic ketoacidosis in a newly diagnosed type 1 diabetes mellitus patient; case based review. International Journal of Clinical Cases and Investigations. 2012;4(1):54–60.
    1. Wolfgram P. M., Macdonald M. J. Severe hypertriglyceridemia causing acute pancreatitis in a child with new onset type i diabetes mellitus presenting in ketoacidosis. Journal of Pediatric Intensive Care. 2013;2(2):77–80.
    1. Fulop M., Eder H. Severe hypertriglyceridemia in diabetic ketosis. The American Journal of the Medical Sciences. 1990;300(6):361–365. doi: 10.1097/00000441-199012000-00004.
    1. Chait A., Brunzell J. D. Chylomicronemia syndrome. Advances in Internal Medicine. 1992;37:249–273.
    1. Yuen N., Anderson S. E., Glaser N., Tancredi D. J., O'Donnell M. E. Cerebral blood flow and cerebral edema in rats with diabetic ketoacidosis. Diabetes. 2008;57(10):2588–2594. doi: 10.2337/db07-1410.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel