Published Paper Details:

Abstract: Background: The simultaneous occurrence of diabetic ketoacidosis (DKA), hypertriglyceridemia-induced acute pancreatitis (HIAP), and Gram-negative bacteraemia represents an exceptionally rare and clinically challenging constellation in young adults. The triad demands meticulous diagnostic reasoning because each condition can mask or mimic the others. Case Summary: A 25-year-old male with no prior documented diabetes mellitus presented to the emergency department with a three-day history of progressive altered sensorium, breathlessness at rest (MMRC Grade IV), diffuse chest pain, low-grade fever, inability to ambulate, and bowel and bladder incontinence. Investigations confirmed DKA, markedly elevated pancreatic enzymes (serum amylase 597 U/L; serum lipase 235 U/L), bilateral pleural effusions, ascites, and blood culture positivity for Serratia marcescens. A critically depressed C-peptide level (0.14 ng/mL) was consistent with new-onset Type 1 Diabetes Mellitus. The patient was managed in the medical intensive care unit (MICU) with aggressive intravenous fluid resuscitation, insulin infusion, electrolyte replacement, and targeted antimicrobial therapy. Conclusion: This case underscores the importance of a broad diagnostic approach in DKA, particularly the measurement of serum triglycerides, lipase, and amylase, as HIAP may perpetuate DKA in a vicious cycle. Concurrent Gram-negative bacteraemia further compounds morbidity and mandates early blood cultures with targeted therapy. Awareness of this triad can significantly alter the management strategy and improve outcomes.