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• W2029089909 abstract "Milky serum (Figure 1) was often noted during blood letting in the seventeenth century, and later reported in association with diabetes mellitus, abdominal pain and eruptive xanthomata.1, 2 The latter are papules with yellow centres that appear over extensor surfaces and are a clinical clue to severe hypertriglyceridemia. As the plasma triglyceride levels climb above 20 mmol/l, there is the likelihood of acute pancreatitis, often resulting in admission to the surgical ward with abdominal pain where the significance of the underlying metabolic abnormality may be missed. So it was with this 37 year old lady who presented to the surgical department with non-specific abdominal pain thought to be acute appendicitis. Suspicion that all was not as it seemed was aroused when the pathology department telephoned to say that they couldn't analyse the blood sample because of grossly lipaemic plasma. The nursing staff had also noted heavy glycosuria, so medical opinion was sought. The patient was not known to have diabetes, but her admission blood glucose was 13.1 mmol/l. Multiple eruptive xanthomata were noted over the elbows and back (Figure: 2a & 2b). A subsequent lipid analysis revealed a total cholesterol of 43 mmol/l and triglycerides of 55 mmol/l. The HbA1c was 10.5% (normal < 6.4%). Her body mass index was 24.9, but over the proceeding few months she had lost about 5 kgs in weight, and reported mild polyuria and polydipsia. Her mother who had type 2 diabetes and hyperlipidemia died from a myocardial infarction at the age of 46 years. Her father had a stroke at the age of 52, and had high blood cholesterol. Our patient was initially treated with intravenous fluids and insulin, and her abdominal pain settled without surgical intervention. A low fat diet was started to limit chylomicron formation and the cholesterol fell to 10 mmol/l and the triglycerides to 17.6 mmol/l over 12 weeks without any drug therapy. At this stage she was lost to follow up when she moved away. Diabetes frequently accompanies the type V hyperlipoproteinemia phenotype that is characterised by elevated levels of chylomicrons and VLDL, both of which compete for the same clearance pathway (lipoprotein lipase).3 Overproduction of hepatic VLDL in those with diabetes overloads the system, resulting in milky serum following meals that may last for days rather than hours. Initial treatment by diet is usually effective, but restriction to as little as 10 grams fat/day may be necessary. Hypoglycaemic agents and fibrates may also be required.4" @default.
• W2029089909 created "2016-06-24" @default.
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• W2029089909 date "2002-01-01" @default.
• W2029089909 modified "2023-10-04" @default.
• W2029089909 title "Milky Serum:" @default.
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• W2029089909 doi "https://doi.org/10.1002/pdi.252" @default.
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