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Affiliations

Aurora Sinai Medical Center

Abstract

Introduction/Background:

Hypertriglyceridemia is the third most common cause of acute pancreatitis after alcohol use and gallstones. While plasmapheresis and insulin are key treatments for hypertriglyceridemia-induced pancreatitis, logistical factors must be considered when selecting a regimen.

Description:

A 38-year-old male with no significant medical history presented with one day of severe abdominal pain. He had consumed a large amount of fatty foods at a party the night before. He was diagnosed with acute necrotizing hypertriglyceridemia-induced pancreatitis. Due to delays in initiating plasmapheresis, concerns over equipment availability, and cost barriers for this unemployed patient, plasmapheresis was not pursued. Instead, he was started on an insulin drip, D5 infusion, normal saline, and pain management. The patient had an elevated blood glucose level and hemoglobin A1c of 8.7. Gastroenterology and endocrinology were consulted, and he was started on daily insulin glargine, lispro, fenofibrate, and pantoprazole for duodenitis. His IV fluids were transitioned to a D5 normal saline infusion. Due to recurrent nausea and vomiting, he was placed NPO, a nasogastric tube was inserted, and meropenem was initiated on day 3 for fevers and leukocytosis. However, infected necrosis was ruled out via CT, and meropenem was discontinued on day 6 as his white blood cell count improved. His diet was slowly advanced. By day 7, his triglyceride levels had decreased to an acceptable level, and the insulin drip was stopped. D5 normal saline was transitioned to lactated ringers. By day 9, the nasogastric feeds and IV fluids were discontinued. On day 10, he was discharged home with insulin, fenofibrate, and atorvastatin.

Discussion:

This case highlights the complexity of managing hypertriglyceridemia-induced pancreatitis in critically ill patients and underscores the importance of early diagnosis and intervention. Given the potential for severe complications, logistical factors such as time, cost, and equipment availability should be considered early in treatment planning.

Presentation Notes

Presented at Scientific Day; May 21, 2025; Park Ridge, IL.

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May 21st, 11:41 AM May 21st, 1:15 PM

Acute Necrotizing Hypertriglyceridemia-Induced Pancreatitis

Introduction/Background:

Hypertriglyceridemia is the third most common cause of acute pancreatitis after alcohol use and gallstones. While plasmapheresis and insulin are key treatments for hypertriglyceridemia-induced pancreatitis, logistical factors must be considered when selecting a regimen.

Description:

A 38-year-old male with no significant medical history presented with one day of severe abdominal pain. He had consumed a large amount of fatty foods at a party the night before. He was diagnosed with acute necrotizing hypertriglyceridemia-induced pancreatitis. Due to delays in initiating plasmapheresis, concerns over equipment availability, and cost barriers for this unemployed patient, plasmapheresis was not pursued. Instead, he was started on an insulin drip, D5 infusion, normal saline, and pain management. The patient had an elevated blood glucose level and hemoglobin A1c of 8.7. Gastroenterology and endocrinology were consulted, and he was started on daily insulin glargine, lispro, fenofibrate, and pantoprazole for duodenitis. His IV fluids were transitioned to a D5 normal saline infusion. Due to recurrent nausea and vomiting, he was placed NPO, a nasogastric tube was inserted, and meropenem was initiated on day 3 for fevers and leukocytosis. However, infected necrosis was ruled out via CT, and meropenem was discontinued on day 6 as his white blood cell count improved. His diet was slowly advanced. By day 7, his triglyceride levels had decreased to an acceptable level, and the insulin drip was stopped. D5 normal saline was transitioned to lactated ringers. By day 9, the nasogastric feeds and IV fluids were discontinued. On day 10, he was discharged home with insulin, fenofibrate, and atorvastatin.

Discussion:

This case highlights the complexity of managing hypertriglyceridemia-induced pancreatitis in critically ill patients and underscores the importance of early diagnosis and intervention. Given the potential for severe complications, logistical factors such as time, cost, and equipment availability should be considered early in treatment planning.

 

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