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Moderate Hypertriglyceridemia Causing Recurrent Pancreatitis: A Case Report and the Literature Review.
Case Rep Gastrointest Med. 2018; 2018:8714390.CR

Abstract

Recurrent acute pancreatitis secondary to hypertriglyceridemia (HTG) with levels below 1000 mg/dL has been rarely reported in the literature. HTG is the third most common cause of acute pancreatitis and has been established in the literature as a risk factor when levels are greater than 1000 mg/dL. A 43-year-old patient presented to the hospital with severe epigastric abdominal pain. Initial laboratory investigations were significant for a lipase level of 4143 U/L and a triglyceride level of 600 mg/dL. Computed tomography (CT) of the abdomen showed diffuse enlargement of the pancreas consistent with pancreatitis. A diagnosis of severe acute pancreatitis secondary to high triglycerides was made based on the revised Atlanta classification 2012. The patient was initially managed with intravenous boluses of normal saline followed by continuous insulin infusion. Diabetic Ketoacidosis (DKA) was ruled out due to a past medical history of diabetes. Her clinical course was complicated by acute respiratory distress syndrome requiring intubation and mechanical ventilation. During the course, she improved symptomatically and was extubated. She was started on nasogastric feeding initially and subsequently switched to oral diet as tolerated. After initial management of HTG with insulin infusion, oral gemfibrozil was started for long-term treatment of HTG. Emerging literature implicates HTG as an independent indicator of poor prognosis in acute pancreatitis (AP). Despite the paucity of data, the risk of developing AP must be considered even at triglyceride levels lower than 1000 mg/dL.

Authors+Show Affiliations

Department of Medicine and Gastroenterology, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, NY, USA.Department of Medicine and Gastroenterology, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, NY, USA.Department of Medicine and Gastroenterology, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, NY, USA.Department of Medicine and Gastroenterology, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, NY, USA.Department of Medicine and Gastroenterology, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, NY, USA.Department of Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

30345124

Citation

Gayam, Vijay, et al. "Moderate Hypertriglyceridemia Causing Recurrent Pancreatitis: a Case Report and the Literature Review." Case Reports in Gastrointestinal Medicine, vol. 2018, 2018, p. 8714390.
Gayam V, Mandal AK, Garlapati P, et al. Moderate Hypertriglyceridemia Causing Recurrent Pancreatitis: A Case Report and the Literature Review. Case Rep Gastrointest Med. 2018;2018:8714390.
Gayam, V., Mandal, A. K., Garlapati, P., Khalid, M., Gill, A., & Mowyad, K. (2018). Moderate Hypertriglyceridemia Causing Recurrent Pancreatitis: A Case Report and the Literature Review. Case Reports in Gastrointestinal Medicine, 2018, 8714390. https://doi.org/10.1155/2018/8714390
Gayam V, et al. Moderate Hypertriglyceridemia Causing Recurrent Pancreatitis: a Case Report and the Literature Review. Case Rep Gastrointest Med. 2018;2018:8714390. PubMed PMID: 30345124.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Moderate Hypertriglyceridemia Causing Recurrent Pancreatitis: A Case Report and the Literature Review. AU - Gayam,Vijay, AU - Mandal,Amrendra Kumar, AU - Garlapati,Pavani, AU - Khalid,Mazin, AU - Gill,Arshpal, AU - Mowyad,Khalid, Y1 - 2018/09/24/ PY - 2018/03/31/received PY - 2018/08/19/revised PY - 2018/09/09/accepted PY - 2018/10/23/entrez PY - 2018/10/23/pubmed PY - 2018/10/23/medline SP - 8714390 EP - 8714390 JF - Case reports in gastrointestinal medicine JO - Case Rep Gastrointest Med VL - 2018 N2 - Recurrent acute pancreatitis secondary to hypertriglyceridemia (HTG) with levels below 1000 mg/dL has been rarely reported in the literature. HTG is the third most common cause of acute pancreatitis and has been established in the literature as a risk factor when levels are greater than 1000 mg/dL. A 43-year-old patient presented to the hospital with severe epigastric abdominal pain. Initial laboratory investigations were significant for a lipase level of 4143 U/L and a triglyceride level of 600 mg/dL. Computed tomography (CT) of the abdomen showed diffuse enlargement of the pancreas consistent with pancreatitis. A diagnosis of severe acute pancreatitis secondary to high triglycerides was made based on the revised Atlanta classification 2012. The patient was initially managed with intravenous boluses of normal saline followed by continuous insulin infusion. Diabetic Ketoacidosis (DKA) was ruled out due to a past medical history of diabetes. Her clinical course was complicated by acute respiratory distress syndrome requiring intubation and mechanical ventilation. During the course, she improved symptomatically and was extubated. She was started on nasogastric feeding initially and subsequently switched to oral diet as tolerated. After initial management of HTG with insulin infusion, oral gemfibrozil was started for long-term treatment of HTG. Emerging literature implicates HTG as an independent indicator of poor prognosis in acute pancreatitis (AP). Despite the paucity of data, the risk of developing AP must be considered even at triglyceride levels lower than 1000 mg/dL. SN - 2090-6528 UR - https://www.unboundmedicine.com/medline/citation/30345124/Moderate_Hypertriglyceridemia_Causing_Recurrent_Pancreatitis:_A_Case_Report_and_the_Literature_Review_ L2 - https://dx.doi.org/10.1155/2018/8714390 DB - PRIME DP - Unbound Medicine ER -
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