Indian Journal of Medical Biochemistry

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VOLUME 25 , ISSUE 2 ( May-August, 2021 ) > List of Articles


Turbid Challenge in Diabetic Ketoacidosis

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.

DOI: 10.5005/jp-journals-10054-0185

License: CC BY-NC 4.0

Published Online: 29-10-2021

Copyright Statement:  Copyright © 2021; The Author(s).


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.

  1. Calmarza P, Cordero J. Lipemia interferences in routine clinical biochemical tests. Biochem Med 2011;21(2):160–166. DOI: 10.11613/bm.2011.025.
  2. Nokilac N. Lipemia: causes, interference mechanisms, detection and management. Biochem Med 2014;24(1):57–67. DOI: 10.11613/BM.2014.008.
  3. Singla AA, Ting F, Singla A. Acute pancreatitis secondary to diabetic ketoacidosis induced hypertriglyceridemia in a young adult with undiagnosed type 2 diabetes. JOP 2015;16(2):201–204. DOI: 10.6092/1590-8577/2961.
  4. Kota S, Jammula S, Kota S, et al. Acute pancreatitis in association with diabetic ketoacidosis in a newly diagnosed type 1 diabetes mellitus patient; case based review. IJCCI 2012;4:54–60.
  5. Argueta EE, Nugent KM. Acute pancreatitis in a patient with diabetic ketoacidosis and normal lipase levels. ICU Director 2013;4(4):166–169. DOI: 10.1177/1944451613488419.
  6. Yadav D, Nair S, Norkus E, et al. Nonspecific hyperamylasemia and hyperlipasemia in diabetic ketoacidosis: incidence and correlation with biochemical abnormalities. Am J Gastroenterol 2000;95(11):3123–3128. DOI: 10.1111/j.1572-0241.2000.03279.x.
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