Hyperlipasemia in Diabetic Ketoacidosis

Abstract

A 48-year-old man presented to our institution with intractable nausea and vomiting. His symptoms had evolved over the past 24 hours. He did not complain of fever, abdominal pain, diarrhea, or constipation. His medical history was significant for type 2 diabetes of 5 years' duration. The patient was supposed to be taking NPH/regular insulin, 25 units subcutaneously, twice daily. He was not on any oral antihyperglycemics. He had not been taking his insulin for a week because he ran out of medical insurance coverage. He denied alcohol use. On admission, he was tachycardic, but his other vital signs were normal. His BMI was 22.6. kg/m2. His abdomen was soft, nontender, and nondistended, and there was no evidence of abdominal organomegaly. The remainder of his systemic examination was normal. Preliminary blood work revealed an elevated white blood cell count of 11,900/mm3 without a left shift. His chemistry panel was significant for a sodium level of 127 mEq/L, potassium level of 2.8 mEq/L, and bicarbonate level of 6 mEq/L. His anion gap was elevated at 24. His blood glucose level was 589 mg/dl, and urine ketones were present (33 mg/dl). His A1C, when checked 2 months …