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Acute Pancreatitis Secondary to Severe Hypertriglyceridemia: Management of Severe Hypertriglyceridemia in Emergency Setting.
Gastroenterology Res. 2017 Jun; 10(3):190-192.GR

Abstract

Hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis (AP). The incidence of AP is around 10-20% with levels > 2,000 mg/dL. We present here a case of a 44-year-old male with history of uncontrolled diabetes mellitus and HTG admitted with severe abdominal pain. Labs revealed elevated lipase and amylase. CT of abdomen with contrast showed AP. He was found to have a triglyceride (TG) level of 6,672 mg/dL. Besides conventional treatment for AP with intravenous (IV) hydration, he was started on IV regular insulin along with dextrose saline. He had marked improvement in his TG level the next day. He was continued on insulin and dextrose saline with hourly glucose monitoring until TG was < 500 mg/dL. He was discharged on statins and fenofibrate. The goal of management of AP secondary to severe HTG in emergency setting is to lower the TG levels to less than 500 as quickly as possible as lower levels are associated with good clinical outcomes. Apheresis and IV insulin are both helpful in lowering TG levels with no randomized controlled trials showing greater efficacy of one over other. Further episodes of AP can be prevented by lifestyle modification and lipid lowering drugs to keep TG levels below 500 mg/dL. Fibrates are first-line drugs to lower TG and used either alone or in conjunction with statins. Periodic plasmapheresis can also be considered in some non-compliant patients with recurrent episodes of pancreatitis.

Authors+Show Affiliations

Department of Medicine, Bassett Medical Center, Cooperstown, NY, USA.Department of Medicine, Bassett Medical Center, Cooperstown, NY, USA.Dow University of Health and Sciences, Karachi, Pakistan.Cleveland Clinic Foundation, Cleveland, OH, USA.Department of Endocrinology, Bassett Medical Center, Cooperstown, NY, USA.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

28725307

Citation

Chaudhary, Ahmad, et al. "Acute Pancreatitis Secondary to Severe Hypertriglyceridemia: Management of Severe Hypertriglyceridemia in Emergency Setting." Gastroenterology Research, vol. 10, no. 3, 2017, pp. 190-192.
Chaudhary A, Iqbal U, Anwar H, et al. Acute Pancreatitis Secondary to Severe Hypertriglyceridemia: Management of Severe Hypertriglyceridemia in Emergency Setting. Gastroenterology Res. 2017;10(3):190-192.
Chaudhary, A., Iqbal, U., Anwar, H., Siddiqui, H. U., & Alvi, M. (2017). Acute Pancreatitis Secondary to Severe Hypertriglyceridemia: Management of Severe Hypertriglyceridemia in Emergency Setting. Gastroenterology Research, 10(3), 190-192. https://doi.org/10.14740/gr762e
Chaudhary A, et al. Acute Pancreatitis Secondary to Severe Hypertriglyceridemia: Management of Severe Hypertriglyceridemia in Emergency Setting. Gastroenterology Res. 2017;10(3):190-192. PubMed PMID: 28725307.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute Pancreatitis Secondary to Severe Hypertriglyceridemia: Management of Severe Hypertriglyceridemia in Emergency Setting. AU - Chaudhary,Ahmad, AU - Iqbal,Umair, AU - Anwar,Hafsa, AU - Siddiqui,Hafiz Umair, AU - Alvi,Madiha, Y1 - 2017/06/30/ PY - 2017/05/10/received PY - 2017/05/12/accepted PY - 2017/7/21/entrez PY - 2017/7/21/pubmed PY - 2017/7/21/medline KW - Acute pancreatitis KW - Apharesis KW - Intravenous insulin KW - Severe hypertriglyceridemia SP - 190 EP - 192 JF - Gastroenterology research JO - Gastroenterology Res VL - 10 IS - 3 N2 - Hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis (AP). The incidence of AP is around 10-20% with levels > 2,000 mg/dL. We present here a case of a 44-year-old male with history of uncontrolled diabetes mellitus and HTG admitted with severe abdominal pain. Labs revealed elevated lipase and amylase. CT of abdomen with contrast showed AP. He was found to have a triglyceride (TG) level of 6,672 mg/dL. Besides conventional treatment for AP with intravenous (IV) hydration, he was started on IV regular insulin along with dextrose saline. He had marked improvement in his TG level the next day. He was continued on insulin and dextrose saline with hourly glucose monitoring until TG was < 500 mg/dL. He was discharged on statins and fenofibrate. The goal of management of AP secondary to severe HTG in emergency setting is to lower the TG levels to less than 500 as quickly as possible as lower levels are associated with good clinical outcomes. Apheresis and IV insulin are both helpful in lowering TG levels with no randomized controlled trials showing greater efficacy of one over other. Further episodes of AP can be prevented by lifestyle modification and lipid lowering drugs to keep TG levels below 500 mg/dL. Fibrates are first-line drugs to lower TG and used either alone or in conjunction with statins. Periodic plasmapheresis can also be considered in some non-compliant patients with recurrent episodes of pancreatitis. SN - 1918-2805 UR - https://www.unboundmedicine.com/medline/citation/28725307/Acute_Pancreatitis_Secondary_to_Severe_Hypertriglyceridemia:_Management_of_Severe_Hypertriglyceridemia_in_Emergency_Setting_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/28725307/ DB - PRIME DP - Unbound Medicine ER -
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