Severe asymptomatic hypertriglyceridemia promoted by uncontrolled fructose ingestion in newly diagnosed type 2 diabetes treated with plasmapheresis

Background Severe forms of dyslipidemia (with triglyceride (TG) levels exceeding 2000 mg / dL) are rare in diabetes mellitus (T2DM). Excessive fructose consumption can lead to severe hypertriglyceridemia by de novo hepatic lipogenesis.

Aim To present an unusual case of severe asymptomatic hypertriglyceridemia and newly diagnosed T2DM without diabetic ketoacidosis (DKA), in patient who reported excessive fructose consumption over the last weeks prior to presentation.

Case presentation A previously healthy 58-year-old man was referred to the emergency department due to severe lipemia (TG 9182 mg / dL, cholesterol 1327 mg / dL) and newly diagnosed diabetes (glucose of 572 mg / dL, HbA1c 17,3 %). The patient reported blurred vision and intentional weight loss of 14 kg over the last four weeks, with diet consisting of excessive amounts of fruit juices (15 L per day) and almost no solids. The vital signs, physical exam, past and family history were unremarkable. The initial clinical and laboratory findings could confidently rule out DKA. Lipase levels were closely monitored and remained unremarkable. Lipid electrophoresis revealed Fredrickson´s type IV dyslipidemia. Plasmapheresis yielded prompt reduction of TG, after initial treatment with intravenous volume and insulin has failed. The patient was discharged 6 days after admission on subcutaneous insulin and atorvastatin. At two-week follow up his TG were 419 mg / dL, total cholesterol 221 mg / dL, and HbA1c 12,7 %.

Conclusion Severe hyperlipidemia might be triggered by excessive fructose intake in patient with uncontrolled newly diagnosed T2DM, absence of ketoacidosis and measurable serum C-peptide. Acute pancreatitis does not necessarily complicate severe hypertriglyceridemia.

Publication History

Article published online:
06 May 2021