Diabetic Ketoacidosis with Severe Dyslipidemia in a Pediatric Patient with New-Onset Type 1 Diabetes Mellitus: A Case Report

Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM). Although mild hypertriglyceridemia (HTG) is common in DKA, severe HTG (triglycerides >2000 mg/dL) is rare in pediatric patients and markedly increases the risk of acute pancreatitis (AP). This report describes a unique case of new-onset T1DM presenting with DKA and extreme dyslipidemia, highlighting management challenges. An 11-year-old girl presented with fatigue, dehydration, and Kussmaul breathing. Laboratory tests confirmed DKA (pH 7.01, blood glucose 490 mg/dL) and showed a severely lipemic blood sample. Initial management included fluid resuscitation and an intravenous insulin infusion. Although DKA resolved within 48 hours, triglyceride (TG) levels surged from 1271 to 3967 mg/dL on the fourth day after reducing the intravenous insulin infusion rate from 0.1 to 0.05 IU/kg/h, accompanied by mild abdominal pain. AP was ruled out by ultrasound, and enzyme levels were normal. Management required readjusting the insulin infusion rate and initiating oral lipid-lowering agents (fenofibrate, rosuvastatin, and omega-3). TG levels normalized within 20 days, though low-density lipoprotein (LDL) remained elevated, consistent with the beta shift phenomenon. A significant family history of hyperlipidemia suggested a genetic predisposition. Severe HTG is a critical complication of pediatric DKA that requires prompt recognition and treatment. Intravenous insulin remains the primary treatment, but clinicians must monitor for rebound lipid levels after acidosis resolves. Oral lipid-lowering therapies are effective adjuncts, especially when plasmapheresis is unavailable. This case emphasizes the need for individualized management and long-term lipid monitoring in pediatric T1DM.