Strawberry pink blood: hypertriglyceridaemia and diabetic ketoacidosis secondary to poorly controlled type 2 diabetes mellitus

• Published in: BMJ case reports Vol. 14; no. 8; p. e243696
• Main Authors: Tan, Timothy Xin Zhong, Lim, Steven Hoon Chin, Khoo, Joan
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 20.08.2021; BMJ Publishing Group
• Subjects: Abdomen; Acidosis; Blood tests; Cardiac arrhythmia; Case Report; Case reports; Diabetes; Diabetic ketoacidosis; Drug overdose; Electrolytes; Glucose; Hyperkalemia; Hypokalemia; Insulin; Laboratories; Malnutrition; Metabolism; Pancreatitis; Sepsis; Triglycerides
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2021-243696

A 54-year-old woman with insulin-requiring type 2 diabetes mellitus presented with acute shortness of breath and drowsiness on a background of polydipsia, weakness and significant weight loss. One year ago, she had decided to stop her insulin and other medications and adopt lifestyle modifications instead. Initial emergency department (ED) blood samples were highly lipaemic and appeared strawberry pink. She was eventually diagnosed with diabetic ketoacidosis (DKA) with severe hypertriglyceridaemia, intubated for airway protection, and managed with fluid resuscitation and intravenous insulin to good effect. We share an uncommon DKA presentation at the ED. History was limited as the patient was drowsy and minimally communicative. Physical examination was unremarkable. Blood investigations were also delayed in view of the need for additional centrifugation. These contributed to a paucity of information in the acute setting and resulted in a diagnostic challenge.