PMID- 34747355
OWN - NLM
STAT- Publisher
LR  - 20240220
IS  - 2052-0573 (Print)
IS  - 2052-0573 (Electronic)
IS  - 2052-0573 (Linking)
VI  - 2021
DP  - 2021 Nov 1
TI  - Fructose-induced severe hypertriglyceridemia and diabetes mellitus: a cautionary 
      tale.
LID - EDM210110 [pii]
LID - 10.1530/EDM-21-0110 [doi]
LID - 21-0110
AB  - SUMMARY: Drinking fruit juice is an increasingly popular health trend, as it is 
      widely perceived as a source of vitamins and nutrients. However, high fructose 
      load in fruit beverages can have harmful metabolic effects. When consumed in high 
      amounts, fructose is linked with hypertriglyceridemia, fatty liver and insulin 
      resistance. We present an unusual case of a patient with severe asymptomatic 
      hypertriglyceridemia (triglycerides of 9182 mg/dL) and newly diagnosed type 2 
      diabetes mellitus, who reported a daily intake of 15 L of fruit juice over 
      several weeks before presentation. The patient was referred to our emergency 
      department with blood glucose of 527 mg/dL and glycated hemoglobin (HbA1c) of 
      17.3%. Interestingly, features of diabetic ketoacidosis or hyperosmolar 
      hyperglycemic state were absent. The patient was overweight with an otherwise 
      unremarkable physical exam. Lipase levels, liver function tests and inflammatory 
      markers were closely monitored and remained unremarkable. The initial therapeutic 
      approach included i.v. volume resuscitation, insulin and heparin. Additionally, 
      plasmapheresis was performed to prevent potentially fatal complications of 
      hypertriglyceridemia. The patient was counseled on balanced nutrition and 
      detrimental effects of fruit beverages. He was discharged home 6 days after 
      admission. At a 2-week follow-up visit, his triglyceride level was 419 mg/dL, 
      total cholesterol was 221 mg/dL and HbA1c was 12.7%. The present case highlights 
      the role of fructose overconsumption as a contributory factor for severe 
      hypertriglyceridemia in a patient with newly diagnosed diabetes. We discuss 
      metabolic effects of uncontrolled fructose ingestion, as well as the interplay of 
      primary and secondary factors, in the pathogenesis of hypertriglyceridemia 
      accompanied by diabetes. LEARNING POINTS: Excessive dietary fructose intake can 
      exacerbate hypertriglyceridemia in patients with underlying type 2 diabetes 
      mellitus (T2DM) and absence of diabetic ketoacidosis or hyperosmolar 
      hyperglycemic state. When consumed in large amounts, fructose is considered a 
      highly lipogenic nutrient linked with postprandial hypertriglyceridemia and de 
      novo hepatic lipogenesis (DNL). Severe lipemia (triglyceride plasma level > 9000 
      mg/dL) could be asymptomatic and not necessarily complicated by acute 
      pancreatitis, although lipase levels should be closely monitored. Plasmapheresis 
      is an effective adjunct treatment option for rapid lowering of high serum lipids, 
      which is paramount to prevent acute complications of severe hypertriglyceridemia.
FAU - Dugic, Ana
AU  - Dugic A
AUID- ORCID: 0000-0002-1893-0754
AD  - Department for Gastroenterology, Endocrinology and Metabolic Diseases, Bayreuth 
      University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Bayreuth, 
      Germany.
FAU - Kryk, Michael
AU  - Kryk M
AD  - Department for Gastroenterology, Endocrinology and Metabolic Diseases, Bayreuth 
      University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Bayreuth, 
      Germany.
FAU - Mellenthin, Claudia
AU  - Mellenthin C
AD  - Department of Surgery, HFR Fribourg, Fribourg, Switzerland.
FAU - Braig, Christoph
AU  - Braig C
AD  - Department for Gastroenterology, Endocrinology and Metabolic Diseases, Bayreuth 
      University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Bayreuth, 
      Germany.
FAU - Catanese, Lorenzo
AU  - Catanese L
AD  - Department for Nephrology, Angiology and Rheumatology, Bayreuth University 
      Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Bayreuth, Germany.
FAU - Petermann, Sandy
AU  - Petermann S
AD  - Department for Gastroenterology, Endocrinology and Metabolic Diseases, Bayreuth 
      University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Bayreuth, 
      Germany.
FAU - Kothmann, Jurgen
AU  - Kothmann J
AD  - Department for Nephrology, Angiology and Rheumatology, Bayreuth University 
      Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Bayreuth, Germany.
FAU - Muhldorfer, Steffen
AU  - Muhldorfer S
AD  - Department for Gastroenterology, Endocrinology and Metabolic Diseases, Bayreuth 
      University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Bayreuth, 
      Germany.
LA  - eng
PT  - Journal Article
DEP - 20211101
PL  - England
TA  - Endocrinol Diabetes Metab Case Rep
JT  - Endocrinology, diabetes & metabolism case reports
JID - 101618943
PMC - PMC8630754
EDAT- 2021/11/09 06:00
MHDA- 2021/11/09 06:00
PMCR- 2021/10/18
CRDT- 2021/11/08 08:49
PHST- 2021/10/06 00:00 [received]
PHST- 2021/10/18 00:00 [accepted]
PHST- 2021/11/09 06:00 [pubmed]
PHST- 2021/11/09 06:00 [medline]
PHST- 2021/11/08 08:49 [entrez]
PHST- 2021/10/18 00:00 [pmc-release]
AID - EDM210110 [pii]
AID - 10.1530/EDM-21-0110 [doi]
PST - aheadofprint
SO  - Endocrinol Diabetes Metab Case Rep. 2021 Nov 1;2021:21-0110. doi: 
      10.1530/EDM-21-0110.