SAT-633 Pancreatitis, DKA, & Hypertriglyceridemia: A Case Series of a Terrible Triad

Abstract Disclosure: A.M. San Hernandez: None. S.K. Devineni: None. M.F. Siddiqui: None. The triad of Hypertriglyceridemia, Acute Pancreatitis, and DKA is rarely seen and often severe, with a high rate of complications and mortality.In this study, we present three cases of hypertriglyceridemia-induced Acute Pancreatitis resulting in DKA in an inner-city community hospital. These patients are aged 21, 32, and 45 years old. Past medical history was significant for Diabetes in one of the three patients and one patient had prior episodes of pancreatitis. None of the patients were on lipid-lowering medication prior to hospitalization. All three patients had classic epigastric abdominal pain on arrival. Lipase levels ranged from 123 to 1847 u/L. CT abdomen in all patients was compatible with acute pancreatitis. Initial levels of bicarbonate in all patients were below 12 mEq/L, Anion gaps were above 18 mEq/L, and Beta HydroxyButyrate was above 4.5 mmol/L, thus establishing the diagnosis of DKA. Osmolarity levels ranged from 288 to 328 mOsm/kg. Triglyceride levels were greater than 3000 mg/dL in two patients and 1093 in the third. All patients were treated with fluids, insulin drip, statin, and Fenofibrate. Two of the patients had Acute kidney injury as a complication. Hemoglobin A1C levels in all cases were above 10%. All patients were bridged to subcutaneous insulin during hospitalization and were discharged with levels of triglycerides below 500 and after resolution of pancreatitis. They were discharged on variable doses of basal and bolus insulin, statin, and omega-3 fatty acids.The triad of hypertriglyceridemia, DKA, and pancreatitis represents a unique clinical scenario. Hypertriglyceridemia can precipitate acute pancreatitis, and DKA further complicates the clinical picture. A mortality rate of 80% has been described. The triad is more common in younger, obese men, with a higher incidence among Hispanics. Patients with this triad experience increased complications, including acute kidney injury (AKI), sepsis, systemic inflammatory response syndrome (SIRS), acute respiratory distress syndrome (ARDS), shock, ileus, and the need for parenteral nutrition. With demographics similar to previous studies, two patients were Hispanic (one male, one female), and one was African American (male), all with BMIs over 25. AKI was the most frequent complication, occurring in two patients. There were no other major complications or deaths. Although all complications were resolved by discharge, two patients experienced recurrent pancreatitis within the following year.We hope these cases provide more insight into the association of hypertriglyceridemia-induced acute pancreatitis and development of DKA. Presentation: Saturday, July 12, 2025