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.
Highlights
Diabetic ketoacidosis (DKA) is a common presentation of type 1 diabetes mellitus that requires urgent treatment
Prevalence of severe hypertriglyceridemia was found in about 8% of adults with DKA [4], but few data have been reported in children with severity ranging from asymptomatic to severe acute pancreatitis
The mechanism of hypertriglyceridemia in DKA that has been proposed involves increased free fatty acid (FFA) secretion from adipocytes by counterregulatory hormone stimulation, which results in decreased clearance of VLDL-TG [5]
Summary
Diabetic ketoacidosis (DKA) is a common presentation of type 1 diabetes mellitus that requires urgent treatment. Acute pancreatitis (AP), peripheral venous thrombosis, pulmonary edema, and rhabdomyolysis are only rarely found in patients with DKA [1]. Prevalence of severe hypertriglyceridemia was found in about 8% of adults with DKA [4], but few data have been reported in children with severity ranging from asymptomatic to severe acute pancreatitis. A review of the literature relating to hypertriglyceridemia and its manifestations in children with DKA was performed and is included in this report for purposes of comparison with our patient. We selected only publications (retrospective cohort studies and case reports) about children, adolescents, and young adults who presented with DKA and hypertriglyceridemia. All clinical and laboratory data including age at presentation, initial TG level, diagnosis and treatment of acute pancreatitis, and duration of TG return to normal range were reviewed and summarized
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