Chylomicronaemia; Diabetes Mellitus; Extreme Hypertriglyceridaemia; Lipaemia

ABSTRACTExtreme hypertriglyceridaemia is an uncommon but clinically important manifestation of severe metabolic derangement in diabetes mellitus and may create significant laboratory analytical challenges. A 29-year-old Nigerian man presented with a 1-month history of weight loss, polyuria, polydipsia and dizziness. Initial investigations showed marked hyperglycaemia, with fasting blood glucose of 22.0 mmol/L, and hypertriglyceridaemia of 9.25 mmol/L. Concurrent investigations identified Plasmodium falciparum malaria, Escherichia coli urinary tract infection and Giardia lamblia infection. Despite initial treatment, triglycerides increased to 28.47 mmol/L and subsequently 31.20 mmol/L, with visibly creamy, lipaemic plasma. At the highest triglyceride concentration, HDL cholesterol was below the analytical range and calculated LDL cholesterol was −5.10 mmol/L, illustrating the limitations of routine lipid measurements in severely lipaemic samples. Treatment included intravenous fluids, insulin, metformin, dapagliflozin, fenofibrate,omega-3 fatty acids and antimicrobial therapy. The case highlights the association between severe uncontrolled diabetes and extreme hypertriglyceridaemia and demonstrates how marked lipaemia can compromise routine lipid analysis. Early recognition and appropriate interpretation of extreme hypertriglyceridaemia are important to reduce the risk of complications, particularly acute pancreatitis.