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VOLUME 25 , ISSUE 2 ( May-August, 2021 ) > List of Articles
Nandita M Jindal, Maria Thomas, Ashish K Joy
Keywords : Diabetic ketoacidosis, Electrophoresis, Hypertriglyceridemia, Lipemia, Lipoproteins
Citation Information : Jindal NM, Thomas M, Joy AK. Turbid Challenge in Diabetic Ketoacidosis. Indian J Med Biochem 2021; 25 (2):88-90.
License: CC BY-NC 4.0
Published Online: 29-10-2021
Copyright Statement: Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.
Background: Interference due to lipemia poses major challenges in laboratory analysis. Turbidity in the sample is due to the accumulation of triglyceride (TG)-rich lipoprotein particulates. The most common cause of hypertriglyceridemia is inadequate fasting whereas secondary causes include alcoholism, chronic renal failure, hypothyroidism, and diabetes mellitus. Aim and objective: To analyze a highly lipemic sample received in the laboratory, to aid in diagnosis. Case description: A highly lipemic plasma drawn from a previously well 32-year-old woman presenting to the emergency department with fever, vomiting, breathlessness, and epigastric pain was received in the lab. Increased serum cholesterol (1,067 mg/dL) with highly raised TG levels (16,117 mg/dL) was seen. Insulin was found to be low (4.2 μI/mL) with raised blood glucose (379 mg/dL) and serum was found positive for acetone. Initial serum lipoprotein electrophoresis showed prominent bands of very-low-density lipoprotein (VLDL) and chylomicrons, which after the start of insulin treatment were found to be only of VLDL. The patient was managed as a case of diabetic ketoacidosis subsequently resulting in a fall in the levels of TG (1,022 mg/dL) and glucose (176 mg/dL) and negative serum acetone. Conclusion: We report the approach taken by the laboratory toward a highly turbid serum sample to achieve reliable laboratory results from a patient eventually diagnosed with diabetic ketoacidosis and acute pancreatitis. Clinical significance: Diagnosis of a patient in current times is mostly dependent on accurate laboratory results which are affected by preanalytical variables like lipemia. Appropriate sample handling in such cases as well as using techniques at our disposal like lipid electrophoresis can aid in diagnosis and ruling out differential causes.
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