Acute Necrotizing Pancreatitis Caused by Transient Hypertriglyceridemia in a Patient With DKA and Normal Serum Amylase and Lipase

We report a case of diabetic ketoacidosis (DKA), severe hypertriglyceridemia (HTG), and acute necrotizing pancreatitis in a previously healthy male who presented with epigastric pain. Transient HTG triggered by DKA was the likely cause of his acute pancreatitis (AP). On admission, his serum pancreatic enzymes were within normal limits. He was treated successfully with intravenous insulin therapy and volume resuscitation. This triad of DKA, HTG, and AP has rarely been reported in the literature, but not with normal enzyme levels. Persistent epigastric pain in a patient with DKA and severe HTG should warrant the consideration of AP, even if the pancreatic enzymes are within normal limits.