Diabetic Ketoacidosis Unveiling Severe Hypertriglyceridemia and Acute Mild Pancreatitis: A Rare Initial Manifestation of Type 2 Diabetes Mellitus.

BACKGROUND Diabetic ketoacidosis (DKA) in combination with hypertriglyceridemia-induced acute mild pancreatitis is a rare but life-threatening clinical triad that occurs in a small subset of patients with DKA. It is an exceptionally uncommon initial presentation of type 2 diabetes mellitus in adults. This case highlights the importance of early recognition and multidisciplinary intervention in such complex clinical scenarios. CASE REPORT A 35-year-old man with no known history of diabetes mellitus presented with 3 days of epigastric abdominal pain. Initial laboratory tests confirmed DKA and severe hypertriglyceridemia (triglycerides 2464 mg/dL), with no lipase elevation and no evidence of gallstones or alcohol-related pancreatitis. The patient was treated with intravenous fluids, insulin infusion, and electrolyte replacement under a DKA protocol. He was placed on a fasting regimen (nil per os) and was monitored with serial metabolic panels and lipid assessments. DKA resolved, and triglyceride levels normalized with insulin therapy alone. He was subsequently transitioned to subcutaneous insulin; atorvastatin and fenofibrate were initiated for long-term lipid control. Upon clinical stabilization, he was discharged with diabetic supplies, dietary education, and outpatient endocrinology follow-up. CONCLUSIONS This case underscores a rare initial manifestation of type 2 diabetes as DKA complicated by hypertriglyceridemia-induced mild pancreatitis. Prompt diagnosis and protocol-based management can substantially improve outcomes in such patients. Increased clinician awareness is essential to optimize care in similar cases.