S3349 Hypertriglyceridemia-Induced Acute Pancreatitis Presenting as Diabetic Ketoacidosis in a Non-Diabetic Patient: A Rare Presentation

Introduction: Acute pancreatitis is one of the leading causes of gastro-intestinal related hospital admissions, its most common causes are alcohol and gallstones, but can be related to other causes such as hypertriglyceridemia. Here, we present a rare case of a patient hypertriglyceridemia-induced pancreatitis that presented as diabetic ketoacidosis (DKA) in a non-diabetic patient. Case Description/Methods: A 53-year-old man patient presented to our hospital complaining of epigastric abdominal pain of 3 days duration that was associated with nausea and vomiting. Patient had no previous medical illnesses and was not taking any medications, he denied alcohol use or smoking. He was evaluated in the Emergency department and initial labs showed a high blood sugar of 600 mg/dL. Other labs showed high hydroxybutyrate, elevated Anion gap, and high Lipase, which was 250 U/L. Computed tomography scan of the abdomen showed signs of Acute interstitial pancreatitis, and the patient was admitted as a case of DKA along with Acute pancreatitis. Ultrasound of the gallbladder showed no gallstones. His triglycerides came back at 2500 mg/dL, and was thought to be the reason for his acute pancreatitis. He was started on Intravenous (IV) insulin along with IV fluids. Other labs showed normal Hemoglobin A1c and autoimmune antibodies for diabetes were all negative. He continued to improve, and was off IV insulin and fluids, tolerated oral diet, however he continued to require insulin, and was discharged on home insulin. Discussion: Acute pancreatitis triggering diabetic ketoacidosis (DKA) in individuals without prior diabetes is rare but clinically important. The intense inflammation from pancreatitis can impair pancreatic beta-cell function, causing a temporary drop in insulin production. Combined with the body’s stress response—which raises counter-regulatory hormones like cortisol and catecholamines—this can lead to severe hyperglycemia and ketosis, even in previously healthy individuals. Hypertriglyceridemia often plays a central role, both as a cause of pancreatitis and a contributor to insulin resistance. In such cases, HbA1c is often normal, indicating an acute rather than chronic glucose disturbance. Recognizing this uncommon presentation is crucial, as timely treatment with insulin and supportive care can reverse both conditions and prevent complications.