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Pseudonormoglycemia in diabetic ketoacidosis with elevated triglycerides
M J Rumbak1, T A Hughes, A E Kitabchi
1Department of Medicine, University of Tennessee, Memphis.
The American Journal of Emergency Medicine
|January 1, 1991
Summary
This case report details a patient with diabetic ketoacidosis (DKA) and extreme hypertriglyceridemia, where high triglycerides masked true glucose levels. Prompt treatment with insulin and fluids resolved the DKA and normalized triglyceride levels.
Area of Science:
- Endocrinology
- Clinical Chemistry
Background:
- Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus.
- Extreme hypertriglyceridemia can interfere with laboratory measurements.
- Accurate glucose monitoring is crucial for DKA diagnosis and management.
Observation:
- A 24-year-old male with newly diagnosed diabetes presented with DKA (pH 7.16, HCO3 6.0).
- The patient exhibited extreme hypertriglyceridemia (239.35 mmol/L).
- DKA diagnosis was delayed due to factitiously low serum glucose levels (11 mmol/L) caused by hypertriglyceridemia.
Findings:
- Intravenous insulin and rehydration therapy successfully normalized pH, HCO3, and triglyceride levels.
- This case represents the highest recorded triglyceride level associated with DKA.
- It is the first report linking high triglyceride levels to factitiously low glucose readings in DKA.
Implications:
- Clinicians should consider hypertriglyceridemia as a potential cause of pseudohypoglycemia in DKA patients.
- Awareness of this phenomenon can prevent diagnostic delays and ensure timely, appropriate treatment.
- This highlights the importance of considering sample interferences in laboratory diagnostics, especially in critical care settings.