THERAPEUTIC PLASMAPHERESIS IN PRIMARY PRESENTATION OF DIABETES MELLITUS WITH DIABETIC KETOACIDOSIS, HYPERTRIGLYCERIDEMIA AND ACUTE PANCREATITIS

Abstract

We present a case of severe hypertriglyceridemia-induced acute pancreatitis associated with
diabetic ketoacidosis, managed in the intensive care unit. The patient was a 39-year-old woman, with a
medical history of Graves-Basedow disease, essential arterial hypertension and morbid obesity
(body mass index=31). Firstly, we aggressively corrected hypovolemia and hemodynamic
imbalances (administrating fluids and systemic anticoagulant) and then we focused on the infection
prevention and control of intra-abodminal pressure, for the latter outcome. We decided to start the first
session of plasma exchange. The patient responded well to the treatment applied. Plasma-exchange
was very efficient, reducing TG levels by 60% after the first treatment and achieving a decrease of
77.6% at the third plasmapheresis session. This case was safely and effectively managed with
plasmapheresis (three sessions), antibiotics, multimodal analgesia (intravenous and thoracic
epidural catheter), early jejunal nutrition and forced mobilization. The patient's evolution was
significantly favorable, with a reduction of the peripancreatic necrosis on computer scan, at day 28
and she was discharged with a normal value of TG and without pain or any clinical signs.