Case presentation A 44-year-old woman with type 2 diabetes (T2D) presented to the emergency department with acute epigastric pain radiating to the periumbilical area, accompanied by episodes of vomiting. Medical history T2D managed with glimepiride and metformin for seven years Hypertriglyceridemia, treated with fenofibrate No history of alcohol or tobacco use Two months prior: HbA1c of 11.5% and BMI 27.6 kg/m 2 Initial examination Hemodynamically stable Dyspnea and abdominal tenderness were noted.
Laboratory findings Diabetic decompensation Capillary blood glucose: 4 g/L Ketonuria (+++) Elevated lipase and inflammatory markers C-reactive protein: 82.18 mg/L Hyperleukocytosis (12,390 cells/mm 3 ), predominantly neutrophils Hypertriglyceridemia: 28.14 g/L Low alkaline reserve: 14.1 mmol/L Hyponatremia: 124 mmol/L Abdominal computed tomography (Figure 1) Peripancreatic fat infiltration…
