A Triad of Ketoacidosis, hypertriglyceridemia, and Acute Pancreatitis Associated With Sugar-Sweetened Soft Drinks Abuse in a Caucasian Patient With Uniagnosed Type 2 Diabetes Mellitus

A Triad of Ketoacidosis, Hypertriglyceridemia, and Acute Pancreatitis Associated With Sugar-Sweetened Soft Drinks Abuse in a Caucasian Patient With Undiagnosed Type 2 Diabetes Mellitus.

• Alessandra Vitelli
• Valentina Apuzzi
• Francesco Calderaro
• Olimpia Fattoruso
• Vincenzo Bassi

抄録

ERに入院した24歳の肥満の白人男性は、腹痛、悪心・嘔吐、高血糖、糖尿病性ケトアシドーシス（DKA）を呈した。急性膵炎（AP）の診断は、腹部CTスキャンでトリグリセリドとリパーゼの血清値が上昇していたことから支持された。患者は5日間、定期的なインスリンの点滴、水分補給、電解質補給、スタチン/フィブラート療法で治療を受け、臨床的には改善した。ヘモグロビンA1c値10％，C-ペプチド値正常，グルタミン酸脱炭酸酵素（GAD-65）陰性，膵島細胞自己抗体から，DKAと高トリグリセリド血症（HTG）誘発性APの珍しい3つの異常を呈する新発症2型糖尿病（DM）と診断された．また，DKAは砂糖を加えた清涼飲料水の乱用（清涼飲料ケトーシス）に依存しており，欧米人患者よりもアジア人患者の方が臨床的に高い頻度で発症していることが病歴から示唆された。

A 24-year-old obese Caucasian male, without relevant anamnesis, who was admitted to the ER presented with abdominal pain, nausea and vomiting, hyperglycemia, and diabetic ketoacidosis (DKA). The diagnosis of acute pancreatitis (AP) was supported by increased serum levels of triglycerides and lipase associated with abdominal CT scans. The patient was treated for five days with IV regular insulin, hydration, electrolytes replacement, and statin/fibrate therapy with clinical improvement. Some 10% hemoglobin A1c value, normal C-peptide level and negative glutamic acid decarboxylase (GAD-65), and islet cell autoantibodies suggested the diagnosis of a new-onset type 2 diabetes mellitus (DM) presenting with an uncommon triad of DKA and hypertriglyceridemia (HTG)-induced AP. Anamnestic history suggested that DKA was dependent on sugar-sweetened soft drinks abuse (soft drink ketosis), a clinical association more frequent in Asian than in Western patients.

Copyright © 2020, Vitelli et al.