Severe Hypertriglyceridaemia with Acute Kidney Injury in Paediatric Diabetic Ketoacidosis: A Case Report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Paediatric diabetic ketoacidosis complicated by severe hypertriglyceridaemia and Stage III acute kidney injury (n=1). Intervention: Continuous soluble insulin infusion, single-volume exchange blood transfusion, and haemodialysis. Primary outcome: Clinical resolution and reduction of plasma triglyceride and serum creatinine levels.

Q: What does this research mean for the field?

A multimodal regimen including insulin infusion, exchange blood transfusion, and haemodialysis effectively treats severe hypertriglyceridaemia, hyperviscosity, and acute kidney injury complicating paediatric diabetic ketoacidosis. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ahmad M Raji

doi:10.63270/njp.v53i3.2000086

September 30, 2026Nigerian Journal of PaediatricsOpen Access

Severe Hypertriglyceridaemia with Acute Kidney Injury in Paediatric Diabetic Ketoacidosis: A Case Report

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Why the study?

Severe hypertriglyceridaemia is an uncommon but clinically significant complication of diabetic ketoacidosis requiring early recognition and management, particularly in resource-limited settings.

Key Points

To report the clinical presentation, diagnostic challenges, and multidisciplinary management of severe hypertriglyceridaemia complicated by acute kidney injury and neurological impairment during paediatric diabetic ketoacidosis.
Clinical documentation of a 14-year-old female in Nigeria presenting with diabetic ketoacidosis, altered sensorium, and grossly lipaemic plasma samples.
Treatment protocol consisted of continuous soluble insulin infusion (0.1 IU/kg/hour), a single-volume exchange blood transfusion, and three haemodialysis sessions alongside supportive airway and fluid management.
Lipid panel revealed severe hypertriglyceridaemia with baseline triglycerides of 29.65 mmol/L (2626.1 mg/dL) and total cholesterol of 21.64 mmol/L, which improved to 5.09 mmol/L and 6.92 mmol/L by day 10.
Serum creatinine rose from 420 µmol/L to a peak of 770 µmol/L (eGFR declining from 13 to 7 mL/min/1.73m²), fulfilling Stage III acute kidney injury criteria, before improving to 105.1 µmol/L (eGFR 76.3 mL/min/1.73m²) after haemodialysis.
Glasgow Coma Score deteriorated to 8/15 within the first 24 hours but rapidly recovered to 15/15 following exchange transfusion and dialysis, leading to stable discharge on hospital day 13.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 female adolescent (age 14) in Nigeria with poorly controlled Type 1 Diabetes mellitus presenting with diabetic ketoacidosis complicated by severe hypertriglyceridaemia and Stage III acute kidney injury, managed over a 13-day hospital admission.

I

Intervention

Continuous soluble insulin infusion at 0.1 IU/kg/hour for 7 days, single-volume exchange blood transfusion (on day 3), three sessions of haemodialysis, intravenous fluid resuscitation with isotonic saline and potassium supplementation, and improvised continuous positive airway pressure (CPAP).

O

Outcome

Clinical recovery, neurological improvement (Glasgow Coma Score), renal function recovery (serum creatinine and eGFR), and reduction in plasma triglyceride levels over 13 days of admission.

Early recognition and multidisciplinary management utilizing prolonged insulin infusion, exchange blood transfusion, and haemodialysis can successfully resolve life-threatening severe hypertriglyceridaemia, neurological impairment, and Stage III acute kidney injury in paediatric diabetic ketoacidosis in a resource-limited setting.

Limitations

Lack of access to arterial blood gas analysis, pancreatic enzyme assays, and lipid genetic studies due to resource and logistical constraints
Missed baseline investigative laboratory data due to grossly lipaemic blood samples
Non-availability of plasmapheresis for rapid triglyceride reduction
Lack of access to arterial blood gas analysis, pancreatic enzyme assays, and lipid genetic studies due to poor resources and logistics
Baseline investigative data were missed due to grossly lipaemic blood samples

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Implication

Hypothesis-generating for multimodal management of hypertriglyceridaemia in paediatric DKA with AKI; leaves open generalizability and need for prospective data.

Abstract

Severe hypertriglyceridaemia is an uncommon but clinically significant complication of Diabetic Ketoacidosis (DKA). We report a 14-year-old female with poorly controlled Type 1 Diabetes mellitus who presented with features of DKA complicated by severe hypertriglyceridaemia, hyperviscosity-related neurological impairment and acute kidney injury requiring haemodialysis. Markedly lipaemic plasma observed during exchange blood transfusion prompted lipid evaluation, which revealed significantly elevated plasma triglyceride levels. The clinical management included insulin infusion, haemodialysis, exchange blood transfusion, and supportive care, resulting in a favourable clinical outcome. This case highlights the importance of early recognition and management of hypertriglyceridaemia in DKA, particularly in resource-limited settings.

Discussion

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Cite This Study

Ahmad M Raji (2026) conducted a case report in Paediatric diabetic ketoacidosis complicated by severe hypertriglyceridaemia and Stage III acute kidney injury (n=1). Continuous soluble insulin infusion, single-volume exchange blood transfusion, and haemodialysis was evaluated on Clinical resolution and reduction of plasma triglyceride and serum creatinine levels.

synapsesocial.com/papers/6af0dba03c845ca7837cedb4 https://doi.org/10.63270/njp.v53i3.2000086

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Severe Hypertriglyceridaemia with Acute Kidney Injury in Paediatric Diabetic Ketoacidosis: A Case Report

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Severe Hypertriglyceridaemia with Acute Kidney Injury in Paediatric Diabetic Ketoacidosis: A Case Report

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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