Extreme lipaemic diabetic ketoacidosis in an undiagnosed type 1 diabetes mellitus teenager

This case report describes the presentation of a 17 year old female teenager who presented with a three day history of colicky central abdominal pain, nausea and vomiting. She denied any fever and had no significant past medical history. She is known to have a strong family history of Type 2 diabetes mellitus. Physical examination revealed severe dehydration. She was tachycardic with a feeble pulse. Her bedside capillary blood sugar was 21mmol/L with an arterial blood gas showing severe uncompensated metabolic acidosis with respiratory compensation. Her dipstick urine ketones was 3+. The blood samples taken were grossly lipaemic and turbid which were consistent with severe lipaemic diabetic ketoacidosis. She did not exhibit any stigmata of chronic hyperlipidemia. The fasting triglyceride and low density lipoprotein (LDL) levels were moderately elevated. With aggressive fluid resuscitation and continous intravenous insulin infusion replacement, her lipaemia and ketoacidosis subsequently resolved within 48 hours resulting in euglycemia. She was then switched successfully to basal bolus insulin regimen in which her blood sugars remained well controlled during subsequent follow ups at the specialist clinic.