A case report of type 1 diabetes mellitus with severe hypertriglyceridemia

Mild hypertriglyceridemia is more commonly seen in poorly controlled diabetes and diabetic ketoacidosis (DKA), but severe hypertriglyceridemia with “milky” plasma is a rare finding. A 17-year-old previously healthy female patient presented to our outpatient department with a headache for the last 20 days and lethargy, abdominal pain, and vomiting for 1 day. The random blood glucose taken was 482 mg/dL, and the urinalysis performed showed ketonuria and glycosuria. Diagnosis of DKA was made, and she was started on fluid replacement and insulin infusion, and blood samples were sent for routine investigations. The plasma samples could not be processed due to analytical interference purportedly caused by elevated triglycerides. This was evident as a milky-white supernatant over the stored samples. In patients with DKA, clinicians should be aware of the possibility of associated hypertriglyceridemia caused by severe insulin deficiency as recognition of this has important implications in the management.