ABSTRACT
OBJECTIVE: Severe hypertriglyceridemia (SHTG; plasma triglycerides >1000 mg/dL) is a rare but serious complication in children who develop diabetic ketoacidosis (DKA) from uncontrolled or new-onset type 1 diabetes. METHODS: We present the case of a severely malnourished 16-year-old with a 10-month history of presumed type 2 diabetes managed with lifestyle modifications and metformin, who presented with SHTG, acute pancreatitis, and DKA. On examination, there was no evidence of lipemia retinalis, cutaneous xanthomas, or xanthelasma. He was initially treated with an insulin infusion and intravenous fluids. Despite this treatment, his pancreatitis symptoms worseneed and lipase level increased, necessitating 2 courses of plasmapheresis that immediately resolved his symptoms and dramatically improved his clinical status. He was discharged on hospital day 5. During his hospital admission, islet cell antigen 512, insulin, glutamic acid decarboxylase 65, and zinc transporter 8 autoantibodies were positive in the presence of insulinopenia, consistent with type 1 diabetes. RESULTS: Hypertriglyceridemia and hypercholesterolemia did not recur during follow-up, suggesting that the underlying mechanism for SHTG was insulin deficiency. CONCLUSION: This report of SHTG, DKA, and pancreatitis in an adolescent highlights the safe, early initiation of plasmapheresis as an effective treatment. To our knowledge, plasmapheresis has rarely been used so early in the course of treatment for an adolescent with SHTG, DKA, and acute pancreatitis.
ABSTRACT
OBJECTIVES: This study aims to identify factors specific to the COVID-19 pandemic that affect resident physicians' well-being, identify potential sources of anxiety, and assess for depression and stress among residents. METHODS: A cross-sectional survey was performed in April 2020 that evaluated resident perceptions about COVID-19 pandemic, its impact on their personal lifestyle, and coping mechanisms adopted. The respondents also completed the Beck Depression Inventory-II (BDI-II) and Cohen Perceived Stress Scale (PSS-10). RESULTS: Of 37 residents, 29 completed the survey for a response rate of 78%. We found that 50% of residents harbored increased anxiety due to the pandemic and reported fears of spreading disease. Factors that negatively impacted their well-being included social isolation from colleagues (78%), inability to engage in outdoor activities (82%), and social gatherings (86%). Residents expressed concern about the effect of the COVID-19 pandemic on their didactic education and clinical rotations. The mean PSS-10 total score was 17 (SD = 4.96, range = 0-33) and the mean BDI-II total score was 6.79 (SD = 6.00). Our residents adopted a number of coping mechanisms in response to COVID-19. CONCLUSIONS: We identified factors specific to the COVID-19 pandemic that adversely affected resident physician well-being. Trainees were concerned about the risk of developing COVID-19 and spreading this to their family. Residents also harbored anxiety regarding the effect of COVID-19 on their education. Lifestyle changes including social isolation also resulted in a negative effect on resident well-being. Developing strategies and resources directed to addressing these concerns may help support well-being and alleviate stress and anxiety.
