Diagnostic difficulties encountered in milky serum of a 4 year old baby with severe diabetic ketoacidosis and hypertriglyceridemia causing acute pancreatitis- A case report
Keywords:
Diabetes mellitus type 1, hypertriglyceridaemia, diabetic ketoacidosis, acute pancreatitis, lipemic sample.
Abstract
Milky/ frothy serum samples can be received sporadically in cases of severe hypertriglyceridemia which can pose diagnostic challenge for the routine processing and result generation. We report difficulties encountered in processing of such sample in undiagnosed and comatosed 4 year old girl of new onset type 1 diabetes mellitus, severe diabetic ketoacidosis and hypertriglyceridemia induced acute pancreatitis. She had markedly elevated serum triglycerides [13,846 mg/dL] with high cholesterol [1267 mg/dl], serum amylase [150 U/L], serum lipase [230 U/L], pH 6.85 and bicarbonate 6 mEq/L. Arterial blood gas analysis and urine chemistry were performed for the initial diagnosis. After establishing the diagnosis she was managed with insulin therapy and conservative management. DOI: 10.21276/awch.2017.1233References
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3.)Nair S, Yadav D, Pitchumoni C.S. Association of diabetic ketoacidosis and acute pancreatitis: obervation in 100 consecutive episodes of diabetic ketoacidosis.American J of Gastoentrology 2000; 95(10): 2795 – 2800.
4.)Wolfgram PM, MacDonald MJ. Severe hypertriglyceridaemia causing acute pancreatitis in a child with new onset type 1 diabetes mellitus presenting in ketoacidosis. J Pediatr Intensive care 2013; 2(2): 77 – 80.
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6.)Ma OJ, Rush MD, Godfrey MM, Gaddis G. 2003. Arterial blood gas results rarely influence emergency physician management of patients with suspected diabetic ketoacidosis. ACAD Emerg Med 2013; 10(8): 836 – 841.
7.)Frier BM, Steer CR, Baird JD, Bloomfield S. Misleading plasma electrolytes in diabetic children with severe hyperlipidemia. Arch Dis Child. 1980: 55; 771 – 775.
8.) ,Yadav D,Nair S ,NorkusEP, Pitchumoni CS, Nonspecific hyperamylaesemia and hyperlipasemia in diabetic ketoacidosis:incidence and correlation with biochemical abnormalities. Am J Gastroenterol. 2000; 95: 3123 – 3128.
9.)Hahn SK, Park JH, Lee JH, Lee JK,Kim KA.Severe hypertriglyceridemia in diabetic ketoacidosis accompanied by acute pancreatitis : Case report.J Korean Med Sci 2010;25(9):1375-1378
10) Van Sonnenberg E, P Tehunmoni CS. Prolonged hyperamylasemia in diabetic ketoacidosis. JAMA 1976; 236: 482 – 483.
2.)Saengkaew T, Sahaki trungruang T, Wacharasindhu S, Supornsilchai V. DKA with severe hypertriglyceridaemia and cerebral edema in an adolescent boy: A case study and review of the literature. Case report in Endocrinology 2016;e 4
3.)Nair S, Yadav D, Pitchumoni C.S. Association of diabetic ketoacidosis and acute pancreatitis: obervation in 100 consecutive episodes of diabetic ketoacidosis.American J of Gastoentrology 2000; 95(10): 2795 – 2800.
4.)Wolfgram PM, MacDonald MJ. Severe hypertriglyceridaemia causing acute pancreatitis in a child with new onset type 1 diabetes mellitus presenting in ketoacidosis. J Pediatr Intensive care 2013; 2(2): 77 – 80.
5.)Chaurasiya 0S, Kumar L, Sethi RS .An infant with milky blood: An unusual but treatable case of familial hyperlipidemia. Indian J Biochem 2013: 28(2): 206 – 209.
6.)Ma OJ, Rush MD, Godfrey MM, Gaddis G. 2003. Arterial blood gas results rarely influence emergency physician management of patients with suspected diabetic ketoacidosis. ACAD Emerg Med 2013; 10(8): 836 – 841.
7.)Frier BM, Steer CR, Baird JD, Bloomfield S. Misleading plasma electrolytes in diabetic children with severe hyperlipidemia. Arch Dis Child. 1980: 55; 771 – 775.
8.) ,Yadav D,Nair S ,NorkusEP, Pitchumoni CS, Nonspecific hyperamylaesemia and hyperlipasemia in diabetic ketoacidosis:incidence and correlation with biochemical abnormalities. Am J Gastroenterol. 2000; 95: 3123 – 3128.
9.)Hahn SK, Park JH, Lee JH, Lee JK,Kim KA.Severe hypertriglyceridemia in diabetic ketoacidosis accompanied by acute pancreatitis : Case report.J Korean Med Sci 2010;25(9):1375-1378
10) Van Sonnenberg E, P Tehunmoni CS. Prolonged hyperamylasemia in diabetic ketoacidosis. JAMA 1976; 236: 482 – 483.
Published
2017-01-25
Issue
Section
Case Reports
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