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Hypertriglyceridemia-induced acute pancreatitis treated with insulin and heparin.
Am J Health Syst Pharm. 2012 Feb 01; 69(3):213-6.AJ

Abstract

PURPOSE

A case of hypertriglyceridemia-induced acute pancreatitis that was managed with insulin and heparin is reported.

SUMMARY

A 39-year-old Hispanic man arrived at the emergency department with complaints of abdominal pain, nausea, and vomiting over one day. A computed tomography scan of the abdomen revealed peripancreatic inflammatory changes surrounding the tail of the pancreas, consistent with pancreatitis. Pertinent laboratory test values on admission were as follows: triglyceride concentration, 5366 mg/dL; total cholesterol concentration, 555 mg/dL; amylase concentration, 131 units/L; lipase concentration, 51 units/L; serum glucose concentration, 253 mg/dL; and serum sodium concentration, 128 mmol/L. The patient was diagnosed with hypertriglyceridemia-induced pancreatitis. On hospital day 1, the patient was given nothing by mouth and received a 1-L bolus dose of 0.9% sodium chloride injection, followed by a continuous infusion of 0.9% sodium chloride injection at a rate of 125 mL/hr. Subcutaneous heparin 5000 units every eight hours, sliding-scale regular insulin, and gemfibrozil 600 mg twice daily were initiated. On hospital day 2, the patient's triglyceride concentration decreased to 2962 mg/dL, and his blood glucose concentration was 147 mg/dL. Subcutaneous insulin detemir 25 units daily was ordered, and sliding-scale insulin was continued. Due to continued elevated triglyceride levels, the patient was transitioned from subcutaneous insulin to an i.v. insulin infusion at 0.1 unit/kg/hr in addition to an infusion of 5% dextrose. On hospital day 5, the patient's triglyceride concentration decreased to 717 mg/dL; the insulin-dextrose infusion was discontinued. The patient was discharged on hospital day 6.

CONCLUSION

A 39-year-old man with pancreatitis caused by severe hypertriglyceridemia was treated with a continuous insulin infusion and subcutaneous heparin.

Authors+Show Affiliations

Methodist University Hospital, 1265 Union Avenue, Memphis, TN 38104, USA. jennifertwilla@mlh.orgNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

22261942

Citation

Twilla, Jennifer D., and Jimmie Mancell. "Hypertriglyceridemia-induced Acute Pancreatitis Treated With Insulin and Heparin." American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, vol. 69, no. 3, 2012, pp. 213-6.
Twilla JD, Mancell J. Hypertriglyceridemia-induced acute pancreatitis treated with insulin and heparin. Am J Health Syst Pharm. 2012;69(3):213-6.
Twilla, J. D., & Mancell, J. (2012). Hypertriglyceridemia-induced acute pancreatitis treated with insulin and heparin. American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, 69(3), 213-6. https://doi.org/10.2146/ajhp110144
Twilla JD, Mancell J. Hypertriglyceridemia-induced Acute Pancreatitis Treated With Insulin and Heparin. Am J Health Syst Pharm. 2012 Feb 1;69(3):213-6. PubMed PMID: 22261942.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hypertriglyceridemia-induced acute pancreatitis treated with insulin and heparin. AU - Twilla,Jennifer D, AU - Mancell,Jimmie, PY - 2012/1/21/entrez PY - 2012/1/21/pubmed PY - 2012/5/10/medline SP - 213 EP - 6 JF - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists JO - Am J Health Syst Pharm VL - 69 IS - 3 N2 - PURPOSE: A case of hypertriglyceridemia-induced acute pancreatitis that was managed with insulin and heparin is reported. SUMMARY: A 39-year-old Hispanic man arrived at the emergency department with complaints of abdominal pain, nausea, and vomiting over one day. A computed tomography scan of the abdomen revealed peripancreatic inflammatory changes surrounding the tail of the pancreas, consistent with pancreatitis. Pertinent laboratory test values on admission were as follows: triglyceride concentration, 5366 mg/dL; total cholesterol concentration, 555 mg/dL; amylase concentration, 131 units/L; lipase concentration, 51 units/L; serum glucose concentration, 253 mg/dL; and serum sodium concentration, 128 mmol/L. The patient was diagnosed with hypertriglyceridemia-induced pancreatitis. On hospital day 1, the patient was given nothing by mouth and received a 1-L bolus dose of 0.9% sodium chloride injection, followed by a continuous infusion of 0.9% sodium chloride injection at a rate of 125 mL/hr. Subcutaneous heparin 5000 units every eight hours, sliding-scale regular insulin, and gemfibrozil 600 mg twice daily were initiated. On hospital day 2, the patient's triglyceride concentration decreased to 2962 mg/dL, and his blood glucose concentration was 147 mg/dL. Subcutaneous insulin detemir 25 units daily was ordered, and sliding-scale insulin was continued. Due to continued elevated triglyceride levels, the patient was transitioned from subcutaneous insulin to an i.v. insulin infusion at 0.1 unit/kg/hr in addition to an infusion of 5% dextrose. On hospital day 5, the patient's triglyceride concentration decreased to 717 mg/dL; the insulin-dextrose infusion was discontinued. The patient was discharged on hospital day 6. CONCLUSION: A 39-year-old man with pancreatitis caused by severe hypertriglyceridemia was treated with a continuous insulin infusion and subcutaneous heparin. SN - 1535-2900 UR - https://www.unboundmedicine.com/medline/citation/22261942/Hypertriglyceridemia_induced_acute_pancreatitis_treated_with_insulin_and_heparin_ L2 - https://academic.oup.com/ajhp/article-lookup/doi/10.2146/ajhp110144 DB - PRIME DP - Unbound Medicine ER -