Key result
Intravenous insulin and fasting lower serum triglycerides below 1000 mg/dL in severe pediatric hypertriglyceridemia.
Why the study?
Severe hypertriglyceridemia is an exceedingly rare complication of new-onset type 1 diabetes mellitus with diabetic ketoacidosis in the pediatric population, prompting discussion of its management and potential complications.
Does prolonged intravenous insulin infusion combined with fasting effectively reduce triglyceride levels in pediatric patients presenting with new-onset type 1 diabetes mellitus and severe hypertriglyceridemia?
Case Report (n=5)
No
Does prolonged intravenous insulin infusion combined with fasting effectively reduce triglyceride levels in pediatric patients presenting with new-onset type 1 diabetes mellitus and severe hypertriglyceridemia?
Early lipid screening in pediatric new-onset type 1 diabetes with DKA can identify severe hypertriglyceridemia, guiding prolonged IV insulin infusion past DKA resolution to rapidly clear triglycerides and mitigate acute pancreatitis risk.
Supports IV insulin plus fasting for triglyceride clearance in new-onset pediatric T1D; hypothesis-generating and requires prospective trials before changing practice.
BACKGROUND: Severe hypertriglyceridemia (HTG) as well as diabetic ketoacidosis (DKA) are complications of type 1 diabetes (T1DM). HTG is an exceedingly rare complication in the pediatric population and herein we report a case of HTG at new-onset T1DM in DKA and discuss management and potential complications. CASE PRESENTATION: An 11-year-old previously well patient with a history of fatigue and weight loss presented with: glucose >600 mg/dL, venous blood gas: pH 7.26, pCO2 20 mmHg, PO2 101 mmHg and base deficit 13 with triglyceride level 3573 mg/dL. An insulin drip was continued past criteria for discontinuation to facilitate lipoprotein lipase-based triglyceride metabolism. CONCLUSIONS: Lipemia secondary to severe HTG, though exceedingly rare, may exist in new onset T1DM with DKA. Complicating the diagnosis is the possibility of an analytical error from lipemia causing incongruence in diagnostic criteria. Clinicians should rely on clinical criteria for management and should consider HTG if laboratory data is inconsistent with the clinical picture.
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Fick et al. (2017) conducted a case report in Severe hypertriglyceridemia in new-onset type 1 diabetes mellitus with diabetic ketoacidosis or ketosis (n=5). Intravenous insulin infusion combined with fasting was evaluated on Reduction in serum triglyceride levels (<1000 mg/dL or normalization). Intravenous insulin therapy (0.05-0.23 units/kg/h) combined with fasting effectively reduced serum triglycerides to <1000 mg/dL in all 5 pediatric patients with new-onset type 1 diabetes and severe hypertriglyceridemia.
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