A rare triad of diabetic ketoacidosis, hypertriglyceridemia and acute pancreatitis: a case report

Manoj Kumar, Vijayavarman V., Pawan Kumar, Arindam Das


Diabetic ketoacidosis (DKA), Acute Pancreatitis and Hypertriglyceridemia are an unusual and infrequent presentation of Diabetes. Hypertriglyceridemia leading to acute pancreatitis is most commonly encountered in poorly controlled Diabetics. In this case report we have described a young Type 1 Diabetic female presenting with Diabetic Ketoacidosis and hypertriglyceridemia induced Pancreatitis (HTIP). The proposed mechanism is triglyceride excess is hydrolyzed by pancreatic lipase resulting in the formation of excess free fatty acids. Excess free fatty acids cause acinar cell injury and capillary leakage in pancreatic vascular beds. Hyperlipasemia frequently occurs in DKA without an underlying acute pancreatitis. Half of the patients with HTIP have falsely low or normal serum Amylase. Imaging is required to confirm the diagnosis of pancreatitis. So, high degree of suspicion is required to diagnose this unusual presentation of diabetes.


Diabetic ketoacidosis, Hypertriglyceridemia, Pancreatitis

Full Text:



Fortson MR, Freedman SN, Webster PD. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol. 1995;90(12):2134-9.

Wolff JF. Consider ketosis prone type 2 diabetes as cause of ketoacidosis in adult patients. BMJ. 2012;344:e3540.

Wang ZH, Selstam KE, Eriksson JW. Ketoacidosis occurs in both type 1 and type 2 diabetes- a population-based study from Northern Sweden. Diabetic Med. 2008;25(7):867-70.

Kimura W, Mossner J. Role of hypertriglyceridemia in the pathogenesis of experimental acute pancreatitis in rats. Int J Pancreatol. 1996;20(3):177-84.

Havel RJ. Pathogenesis, differentiation and management of hypertriglyceridemia. Adv Intern Med. 1969;15:117-54.

Saharia P, Margolis S, Zuidema GD, Cameron JL. Acute pancreatitis with hyperlipemia: studies with an isolated perfused canine pancreas. Surg. 1977;82(1):60-7.

Yadav D, Pitchumoni CS. Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol. 2003;36(1):54-62.

Scherer J, Singh V, Pitchumoni CS, Yadav D. Issues in hypertriglyceridemic pancreatitis-an update. J clin Gastroenterol. 2014;48(3):195-203.

Denecker N, Decochez K. Poorly controlled type 2 diabetes complicated by an episode of severe hypertriglyceridaemia-induced pancreatitis. Case Reports. 2013; 2013:bcr2012008455.

Fulop M, Eder H. Severe hypertriglyceridemia in diabetic ketosis. Am J Med Sci. 1990;300(6): 361-5.

Sandhya V, Balasubramanian A, Rajasekar D, Kothai G, Sundari SNM. Pink Blood. Int J Sci Stud. 2014;2(7):209-21.

Shah PC, Patel AR, Rao KR. Hyperlipidemia and spuriously elevated hemoglobin values. Am J Hematol. 1975;82(3):382-3.

Yadav D, Nair S, Norkus EP, Pitchumoni CS. Nonspecific hyperamylasemia and hyperlipasemia in diabetic ketoacidosis: incidence and correlation with biochemical abnormalities. Am J Gastroenterol. 2000;95(11):3123-8.