Green plasma and a blocked CRRT circuit due to drug-induced hyperlipidemia

Abstract

A 46-year-old female, treated with aripiprazole for 2 years for a depressive syndrome, presented to the emergency department with acute respiratory failure. The clinical examination and blood analysis indicated severe diabetic ketoacidosis (blood pH, 6.8; PCO2, 12 mmHg; lactatemia, 2.5 mmol/l; glycemia, 40 mmol/l) and major hypertriglyceridemia of 15 g/l (without pancreatitis; lipasemia, 30 UI/l) and hypercholesterolemia (10 g/l). Management in intensive care consisted of treatment with lipid-lowering rosuvastatin, insulin therapy and continuous renal replacement therapy. The figures show green plasma due to the severe hypertriglyceridemia associated with a thick lipid layer. This thick lipid layer made the blood tests difficult, and the green plasma distorted the colorimetric analyses. The continuous renal replacement therapy was also difficult because of the multiple daily lipid clogging of the filter (Figs. 1, 2). The etiology was iatrogenic, induced by aripiprazole. Genetic analysis found a heterozygous genotype for the GPIHBP1 variant, which may contribute to aggravation of hypertriglyceridemia.