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Yes! you are not MISTAKEN!
Serum Triglycerides (Lipid) levels were 25585 mg/dl.
A 17-year-old boy was referred from the periphery with complaints of abdominal pain, headache for 2 days, and loss of consciousness for 1 day, was admitted to Orange Neonatal & Pediatric Intensive Care Unit on day 2 of illness with MODS, shock, AKI, Pancreatitis, Hypoxia, and DKA. The child’s blood glucose value was more than 500 mg/dl with a GCS score of 4 (E1M2V1), the child was immediately intubated, commenced on ventilator support, and management of shock was started. We took blood for ABGA and Blood investigations, it was like pure “ORANGE ” color blood, in 5 minutes standing it took the color of pure milk. It was due to very severe hypertriglyceridemia, hypercholesterolemia secondary to Severe DKA.
The central line was secured immediately, and the Insulin drip was started as per interim “BSPED DKA 2020” guidelines. Pediatric Endocrinologist opinion was sought for unexpectedly high TGs. The child had persistent seizures due to cerebral edema, Pediatric Neurologist was consulted and AEDs were adjusted. The child had to worsen ATN with AKI & raising creat (6.5) hence HD catheterization was done and Hemodialysis was started under the supervision of a Pediatric Nephrologist. The child showed a magical response to 2 cycles of Hemodialysis. The child was extubated after a week, repeat TGs were showing gradual improvement with last TGs of 150 mg/dl only. Physiotherapy was continued during the hospital stay and early mobilization was considered. The child was shifted on s/c insulin and things got better and better in the next 2 weeks.
Some diseases drag you to your best, definitely, there were difficult times while taking TGs down from 25585 mg/dl to 150 mg/dl, but the multidisciplinary approach of the Team made it a cakewalk in the end.
This is the highest number of triglycerides value noted till date in a child (<18 years), opening a new complication spectrum of simple diseases like DKA. Academically it has opened new doors for researchers as well.
The best part was on the day of discharge when we were like
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