We present a 27-year-old female with only past medical history of gestational diabetes, who presented to our hospital with abdominal pain. Physical exam was significant for mild tachypnea and tachycardia, dry mucous membranes, and moderate epigastric tenderness to light palpation. Blood work revealed an elevated glucose of 411 mg/dl, creatinine of 0.4 mg/dl, severe wide anion gap metabolic acidosis, lipase >6,000, triglycerides (TG) increased to 1,368 mg/dl. Computed tomography of abdomen and pelvis was consistent with acute pancreatitis. She was started on an insulin infusion and intravenous fluids. Her condition worsened rapidly with significant decline in mentation and severe tachypnea requiring intubation. Further blood work showed worsening creatinine at 1.5 with an arterial blood pH of 6.9. Insulin infusion continued and plasmapheresis was initiated given the worsening in her clinical status. Post plasmapheresis, her triglycerides decreased to 259 mg/dl, glucose trending in the 100 range, and anion gap closed. Her severely elevated triglyceride level was attributed to a combined effect of her new onset diabetes and vaginal estrogen ring, which was removed on presentation. Hypertriglyceridemia pancreatitis is a rare cause of pancreatitis. Usually a serum triglyceride (TG) level of more than 1,000 mg/dL is an inciting factor for the episode. In DKA, the deficiency of insulin activates lipolysis in adipose tissue releasing increased free fatty acids, which accelerates formation of VLDL in the liver. In addition, reduced activity of lipoprotein lipase in peripheral tissue decreases removal of VLDL from the plasma, resulting in hypertriglyceridemia. Furthermore, exogenous estrogen use can cause an increase in TG by induced stimulation of the secretion of hepatic triglyceride-rich lipoprotein. Plasmapheresis has been repeatedly shown in case reports and series to be effective in quickly removing TG from the serum of patients with hypertriglyceridemia pancreatitis. Although a clear benefit of plasmapheresis in reducing the severity and improving outcomes in such patients has not been conclusively shown, we report the possible benefit of such therapy as an add-on treatment modality in case the clinical situation deteriorates while they are on standard therapy.