Hypertriglyceridemia
Background
- ~5% of acute pancreatitis caused by high TGs[1]
- Etiologies
- Familial hypertriglyceridemia, autosomal dominant with variable penetrance
- Secondary forms
- DM, obesity, EtOH, estrogen therapy
- Hypothyroidism, ESRD, nephrotic syndrome, HIV, anti-HIV meds
- TG levels > 2000 mg/dL almost always have both secondary and genetic form[2]
Management of Pancreatitis
- Evidence for management based on case series and reports[3][4]
- Insulin drip - most dramatic and rapid intervention, with reduction within 24 hrs
- 5-10 units/hr with dextrose infusion to maintain CBGs ~150 mg/dL
- May require higher dosages for diabetics, 0.1 - 0.5 u/kg/hr
- Heparin SC q8 5000 units
- Niacin 500 mg qd
- Gemfibrozil or fenofibrate
- Diabetic diet, advanced slowly
- Follow TG levels, goal < 500 mg/dL by discharge
Disposition
- ICU for frequent labs, insulin drip
Sources
- ↑ Yadav D, Pitchumoni CS. Issues in hyperlipidemic pancreatitis. J Clin Gastroenterology 2003;36:54-62.
- ↑ Yuan et al. Hypertriglyceridemia: its etiology, effects and treatment. CMAJ 2007;176:1113-1120.
- ↑ Santana YR et al. Treatment of severe hypertriglyceridemia with continuous insulin infusion. Case Reports in Critical Care. June 2011.
- ↑ Poonuru S et al. Rapid Reduction of Severely Elevated Serum Triglycerides with Insulin Infusion, Gemfibrozil and Niacin. Clin Med Res. 2011 Mar; 9(1): 38–41.