A 37-yrs-old man in DKA has yellowish papules scattered over his trunk and extremities. A tube of plasma that is collected from the patient develops a turbid supernate. This is consistent with which type of hyperlipoproteinemia?
**Core Concept**
Type V hyperlipoproteinemia is characterized by elevated levels of chylomicron remnants and VLDL (very low-density lipoprotein) in the plasma. This leads to a pattern of hypertriglyceridemia, which can cause pancreatitis, eruptive xanthomas, and lipemia retinalis.
**Why the Correct Answer is Right**
The patient's symptoms of DKA (diabetic ketoacidosis) and yellowish papules (eruptive xanthomas) suggest an underlying metabolic disorder affecting lipid metabolism. The development of a turbid supernate in the plasma sample indicates the presence of lipids, specifically triglycerides. Type V hyperlipoproteinemia is caused by an imbalance in the clearance of VLDL and chylomicron remnants, leading to an accumulation of triglycerides in the plasma. This condition is often seen in patients with diabetes, obesity, or other metabolic disorders.
**Why Each Wrong Option is Incorrect**
**Option A:** Type I hyperlipoproteinemia is characterized by elevated levels of chylomicrons, which would cause a lipemic band in the plasma, but it does not typically present with a turbid supernate.
**Option B:** Type II hyperlipoproteinemia is characterized by elevated levels of LDL (low-density lipoprotein) cholesterol, which would not cause a turbid supernate or eruptive xanthomas.
**Option C:** Type III hyperlipoproteinemia is characterized by elevated levels of IDL (intermediate-density lipoprotein), which would cause a lipemic band in the plasma, but it does not typically present with a turbid supernate or eruptive xanthomas.
**Clinical Pearl / High-Yield Fact**
Type V hyperlipoproteinemia is often seen in patients with metabolic syndrome, which includes conditions such as insulin resistance, hypertension, and obesity. Early recognition and management of this condition can prevent serious complications such as pancreatitis.
**Correct Answer Line**
✓ Correct Answer: D. Type V.