Unusual case of diabetic ketoacidosis

Abstract

Type-2 Diabetes mellitus may present in several ways, one of which, is Diabetic Ketoacidosis. Diabetes itself may be caused by acute pancreatitis. We discuss a case of 46 years old male, with no history of diabetes mellitus, who was admitted for abdominal pain and vomiting, and finally diagnosed with diabetic ketoacidosis. Serum amylase and lipase could not be measured at admission owing to the heavily lipemic serum. Subsequent measures demonstrated very high levels of lipase. Serum triglycerides were significantly elevated; 3200 mg/dl. Initial computed tomography scan of the abdomen did not reveal findings typical for acute pancreatitis.  
Hypertriglyceridemia-induced pancreatitis leading to overt diabetic ketoacidosis in a previously non-diabetic patient was our leading diagnosis. Lipo-pharesis was instituted shortly after the initiation of intra-venous insulin and fluid resus-citation. Subcutaneous heparin and fibrates were added later on, leading to clinical improvement, and reduction in serum triglycerides and pancreatic enzymes.