to the editor: Occasionally, clinicians encounter a finding that is rarely seen, and thus is worth sharing. The accompanying figure is a serum sample from a 60-year-old woman with diabetes who presented for evaluation of severe abdominal pain, nausea, and vomiting that had been worsening over a 24-hour period. She denied any chest pain, shortness of breath, fever, or chills. A nonfasting lipid panel revealed a triglyceride level of 8,535 mg per dL (96.3 mmol per L; normal range: 40 to 150 mg per dL [0.45 to 1.69 mmol per L]). Her lipase level was elevated at 1,476 U per L (normal range: 23 to 300 U per L).

Approximately 1.3 to 3.8 percent of cases of acute pancreatitis may be secondary to hypertriglyceridemia.¹ Serum triglyceride levels of about 1,000 mg per dL (11.29 mmol per L) can precipitate such attacks, although the exact mechanism is unknown. When the triglyceride level is above 4,500 mg per dL (50.81 mmol per L), as in this patient, the serum is described as lactescent (milk-like). Such appearance should prompt the physician to get an immediate lipid level.¹