alexa Primary Hyperlipidemia, Acute Pancreatitis and ketoacidosis in an Adolescent with Type 2 Diabetes
ISSN: 2155-6156

Journal of Diabetes & Metabolism
Open Access

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Case Report

Primary Hyperlipidemia, Acute Pancreatitis and ketoacidosis in an Adolescent with Type 2 Diabetes

Krisztina Lukacs1,2*, Laszlo Jozsef Barkai1, Nora Hosszufalusi1, Eva Palik1, Attila J Szabo2 and Laszlo Madacsy2

13rd Department of Medicine, Semmelweis University, 1125 Budapest, Hungary

21st Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary

Corresponding Author:
Krisztina Lukacs
3rd Department of Internal Medicine
Semmelweis University, 4 Kutvolgyi Street
1125 Budapest, Hungary
Tel: (36)-20-825-9048
Fax: (36)-1-395-8857
E-mail: [email protected]

Received Date: February 01, 2016; Accepted Date: February 23, 2016; Published Date: February 28, 2016

Citation: Lukacs K, Barkai LJ, Hosszufalusi N, Palik E, Szabo AJ, et al. (2016) Primary Hyperlipidemia, Acute Pancreatitis and ketoacidosis in an Adolescent with Type 2 Diabetes. J Diabetes Metab 7:651. doi:10.4172/2155-6156.1000651

Copyright: © 2016 Lukacs K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

 

Abstract

A case is presented of a 15-year-old boy with a past medical history of hyperlipidemia and hypertension. He attended the emergency department with a 3-day history of vomiting, acute abdominal pain, and altered mental status. Laboratory data on admission revealed metabolic acidosis (pH: 7.12, BE: -20.8 mmol/L), high blood glucose level (32.1 mmol/L) and significant hyperlipidemia (cholesterol: 16.3 mmol/L, triglycerides: 21.1 mmol/L). Treatment with electrolytes and volume replacement and intravenous insulin successfully resolved the ketoacidosis, but the abdominal pain and hyperlipidemia remained. Abdominal US and CT scan showed severe necrotizing pancreatitis with a pseudocyst. The laboratory studies showed a Frederickson type V pattern hyperlipidemia. HbA1c was 14.3% (133 mmol/mol), indicating the presence of chronic glucose elevation. Based on the lack of islet cell antibodies and the normal fasting serum C-peptide level, type 2 diabetes was diagnosed. His HLA DQB1 genotype is associated with neutral autoimmune diabetes risk. The rare and enigmatic triad of diabetic ketoacidosis, hyperlipidemia and acute pancreatitis has been reported in a few adult and childhood cases. The pathomechanism is not clear and the association among the members of the triad may have four different explanations. All previous reports in children, suggest that ketoacidosis occurring in type 1 diabetes as first symptom can cause hyperlipidemia, and consequent acute pancreatitis. However, to the best of our knowledge, this is the first report of a pediatric patient presenting with primary hyperlipidemia-induced acute necrotizing pancreatitis complicated by diabetic ketoacidosis at the onset of non-autoimmune diabetes

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