DKA and lipids

Q: The plasma triglyceride level in patients with Diabetic ketoacidosis (DKA) and Hyperglycemic Hyperosmolar State (HHS) would be? - select one

A) lower

B) elevated

Answer: B

DKA or HHS can cause hyperlipidemia to the point where the serum appears lactescent. This effect is more pronounced in DKA. Levels fall back to normal with insulin therapy.

This occurs due to Lipolysis secondary to insulin deficiency. It also causes elevation of lipolytic hormones such as catecholamines, growth hormone, corticotropin [ACTH], and glucagon. Insulin is the most potent anti-lipolytic hormone; therefore, if DKA or HHS is not treated promptly, ongoing lipolysis releases glycerol and free fatty acids, which cause insulin resistance at both the peripheral and hepatic levels, and serve as substrates for ketoacid generation in hepatocyte mitochondria. In severe cases, it may require plasma exchange.

Another implication of this hyperlipidemia is pseudohyponatremia and/or pseudohyperchloremia. 

#endocrinology

References:

1. Chreitah A, Hijazia K, Doya L, Salloum A. Severe dyslipidemia associated with diabetic ketoacidosis in newly diagnosed female of type 1 diabetes mellitus. Oxf Med Case Reports. 2021 Oct 26;2021(10):omab036. doi: 10.1093/omcr/omab036. PMID: 34729187; PMCID: PMC8557415.

2. Weidman SW, Ragland JB, Fisher JN Jr, et al. Effects of insulin on plasma lipoproteins in diabetic ketoacidosis: evidence for a change in high density lipoprotein composition during treatment. J Lipid Res 1982; 23:171.

3. Huang S, Song F, Gao K, Song Y, Chen X. Plasma exchange treatment of a diabetic ketoacidosis child with hyperlipidemia to avoid pancreatitis: a case report. Front Pediatr. 2024 Jun 5;12:1280330. doi: 10.3389/fped.2024.1280330. PMID: 38903770; PMCID: PMC11188404.